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Aim: The New Zealand National Child Protection Alert System is administered by multidisciplinary teams in every district health board. The aim of this study was to investigate the factors that influence multidisciplinary child protection teams' (MDTs') decisions about whether to place a child protection alert., Method: Members of the Child Protection Alert System teams were invited to participate in semi-structured interviews. Interview data were coded and grouped into themes using inductive thematic analysis., Results: Six themes were identified: the system works well; a wide range of factors are considered in multidisciplinary team decision-making; there are some difficulties with multidisciplinary team meetings; there are problems with the administration of the system across district health boards; there is concern about the potential for the Child Protection Alert System to stigmatise families or cause unjustified responses; improvements can be made to the system., Conclusion: There is overall support for the National Child Protection Alert System and a consensus that the benefits outweigh any potential risks. There is a need for further improvements to the system, including consistent training, further standardisation and increased accessibility of the information to health professionals, including making information on the system available to primary healthcare., Competing Interests: Miranda Ritchie is employed by contract to the Ministry of Health to audit implementation of the National Child Protection Alert System. Patrick Kelly is a member of the Clinical Reference Group of the Child Protection Special Interest Group of the Paediatric Society of New Zealand, which participates in the governance structure and quality assurance mechanisms of the National Child Protection Alert System. This position is unpaid.

Aim: To describe the multi-disciplinary child protection teams which administer the National Child Protection Alert System in District Health Boards in New Zealand and the understanding and perceptions of that system held by team members., Methods: This is a mixed-method observational study. In December 2016 and January 2017, all child protection alert system multi-disciplinary team members were invited to participate in an online survey. Quantitative data were expressed with simple descriptive statistics. Qualitative findings were analysed using thematic analysis., Results: Ninety-one (56.9%) of 160 team members nationwide completed the survey. All 20 District Health Boards and multiple disciplines were represented. Most respondents agreed that they received good information to make decisions (74/90, 82.2%), that it was usually easy to reach consensus (82/91, 90.1%), that the system helped to keep children safe (72/91, 79.1%) and that it did not stigmatise families (49/91, 53.9%). Qualitative analysis identified considerable variation in understanding of the system and a need for more training to support more consistent implementation of the system., Conclusions: Overall, health professionals responsible for the child protection alert system regard it positively but express a need for more training for team members and front-line staff to maximise the system's potential and minimise any risk of stigmatisation., (© 2020 Paediatrics and Child Health Division (The Royal Australasian College of Physicians).)

Few studies explore subjective experiences of attempting to discontinue antipsychotic medication, the withdrawal methods people use, or how their efforts affect their outcomes. People who take antipsychotics for off-label purposes are poorly represented in the literature. This study investigates experiences of attempting to discontinue antipsychotics in a cross-sectional sample and explores potential associations between withdrawal methods, relapse, and success. An anonymous online survey was completed by 105 adults who had taken antipsychotics for any reason and had attempted discontinuation at least once. A mixed methods approach was used to interpret the responses. Just over half (55.2%) described successfully stopping for varying lengths of time. Half (50.5%) reported no current use. People across diagnostic groups reported unwanted withdrawal effects, but these were not universal. Withdrawing gradually across more than one month was positively associated, and relapse was negatively associated with both self-defined successful discontinuation and no current use. Gradual withdrawal was negatively associated with relapse during withdrawal. We conclude it is possible to successfully discontinue antipsychotic medication, relapse during withdrawal presents a major obstacle to successfully stopping AMs, and people who withdraw gradually across more than one month may be more likely to stop and to avoid relapse during withdrawal., (Copyright © 2018. Published by Elsevier B.V.)

Purpose: To explore supports and coping strategies used during attempts to discontinue antipsychotic medication and test for associations with success., Method: 144 people who were taking or had taken antipsychotics completed The Experiences of Antipsychotic Medication Survey. Among them, 105 people had made at least one discontinuation attempt and answered a series of questions about their most recent attempt to stop. Content analysis and Chi-square tests of independence were used to categorise the data and explore associations. Success was defined as stopping all AM use irrespective of the duration of the medication-free period or whether relapse occurred, which were explored separately., Results: Among the 105 people who had attempted discontinuation, 61.9% described unwanted withdrawal effects and 27.6% of the group described psychotic or manic relapse during the withdrawal period. Within this group 55% described successfully stopping all AM for varying lengths of time, half reported no current use, and half described having some form of professional, family, friend, and/or service user or peer support for their attempt. Having support was positively associated with success and negatively associated with both current use, and relapse during withdrawal. A range of coping efforts were described, but having coping strategies failed to show significant associations with any of the dependent variables explored. Among those who described successfully stopping, some described returning to AM for short periods when needed, while others reported managing well with alternative methods alone., Conclusions: Findings cannot be readily generalised due to sampling constraints, but results suggest a wide range of supports and coping strategies may be used when attempting to discontinue antipsychotics. Many people may attempt to discontinue antipsychotics without any support. Those who have support for their attempts may be significantly less likely to relapse during withdrawal and more likely to succeed in their attempt. There is a pressing need for further research in this area.

Background: To assess the postintervention arson recidivism and other offending rates of a group of 182 firesetting children and adolescents referred to the New Zealand Fire Awareness and Intervention Program (FAIP) over a follow-up period of 10 years. To investigate predictors of offending behaviour as well as variables associated with previous involvement in firesetting behaviour and offending severity., Method: Data collected at the time of the FAIP intervention was provided by the New Zealand Fire Service and the offence histories of the sample were accessed from the New Zealand Police database (NIA). Data were analyzed using both descriptive and inferential statistics., Results: Although the arson recidivism rate was low (2%), rates of general offending were high, with 59% of the sample having committed an offence during the follow-up period. Fifteen percent of the sample was classified as severe offenders, 40% as moderate and 4% as minor. Of offenders, 12.6% had been imprisoned during the follow-up period. Offending was predicted by experience of abuse and a previous firesetting behaviour at the time of the FAIP intervention. Living with both parents at the time of intervention decreased the probability of an individual engaging in future offending behaviour. The presence of family stress and a diagnosis of Attention Deficit Disorder or Attention Deficit Hyperactivity Disorder (ADD/ADHD) were associated with previous firesetting behaviour. In addition, involvement with family violence (as a perpetrator, complainant or victim) was associated with more severe offending behaviour., Conclusions: In light of existing research, the findings of this study indicate that many firesetters are at risk for future offending and that identification of high-risk individuals is therefore an important consideration for any organization involved with firesetters. To minimize this risk, there is a need for a collaborative, multiagency approach to firesetting behaviour involving comprehensive risk assessment and appropriate referral for at-risk individuals., (© 2013 The Authors. Journal of Child Psychology and Psychiatry © 2013 Association for Child and Adolescent Mental Health.)

Background: Outcome measurement in child and adolescent mental health services in New Zealand became mandatory in 2005 and little is known about how this is perceived by service users., Aims: This study aimed to ascertain what service users think about routine outcome measurement in child and adolescent mental health services., Method: Nine semi-structured focus groups of child and adolescent service users (n=34) and family members (n=21) were held in different sites in New Zealand to determine their views on outcome measures., Results: Consumers supported outcome assessment with some provisos that have important implications for clinical services: the method of collecting information is critical to acceptance; assessment should be done in the context of an established relationship with the clinician; care is needed over the timing and context of assessment, access to information and feedback of results; and measures should be brief and holistic and their limitations recognised., Conclusion: Service users support outcome measures but their implementation requires care and consultation.

A significant number of children and adolescents engage in deliberate fire setting, beyond the scope of curiosity and experimentation. Interventions developed to respond to the needs of such fire setters generally involve educational and/or psychosocial approaches. Research evaluating the effectiveness of these interventions is dominated by outcome studies which rely on recidivism rates determined by either official records or parent reports. There has however, been no process evaluation studies published. This study presents a process analysis which aimed to identify the strengths and weaknesses of a Fire Awareness and Intervention Program in New Zealand, from the perspectives of program consumers. Qualitative research methods were employed, with data being derived from in-depth interviews with young people and their parents/caregivers. The analysis indicated that (a) the FAIP was generally regarded as a positive experience, (b) practitioners' qualities of empathy and understanding are important for developing rapport with the young people and their parents, (c) education-based intervention tailored to the young person's age and developmental level is important, (d) educational resources need to be updated and used flexibly to respond appropriately to the age and developmental level of the young person, and (e) inter-agency and intra-agency relationships need to be developed and maintained, with formal arrangements for reciprocal referral systems developed in order to respond to the needs of the clients. The resulting implications for service providers, along with future research are discussed., (Copyright © 2012 Elsevier Ltd. All rights reserved.)

Background: The EarlyBird program is a psycho-educational early intervention program for parents of children with autistic spectrum disorder (ASD). It aims to provide parents with skills to increase their child's communication and manage challenging behaviour using behavioural techniques., Method: Two interlinked studies examined access to the EarlyBird program and barriers which may affect uptake. Study 1 investigated who accessed the EarlyBird program, and what factors influenced this choice. Study 2 was a qualitative investigation which focused on barriers to uptake for ethnic minority groups in New Zealand., Results: Findings indicated that approximately 85% of families eligible for the program do not participate. Non-membership of Autism New Zealand (the agency responsible for administering the program), ethnicity, and length of wait time were significant factors in non-participation., Conclusions: A model of factors which may influence uptake of interventions targeting the families of children with a disability is proposed.

Aims: To explore referrals to medical evaluations and children's and primary carers' experiences of those evaluations in Auckland., Methods: Semi-structured interviews were conducted with children and young people who had made clear disclosures of sexual abuse, their primary carers and the social workers involved., Results: More than 90% of children alleging penetration or attempted penetration were referred for a medical evaluation, but less than two thirds of children alleging oral genital or digital contact abuse were referred. Although the majority perceived the medical practitioners positively, many also commented on the distressing nature of the examinations, the photographs of children's genitalia and lack of preparation for those examinations., Conclusions: The findings highlight the need for improved preparation of children and their primary carers for medical evaluations. Ongoing discussion between referring agents and medical practitioners is desirable to ensure protocols are updated and adhered to.

A simple model for general application to the planning and evaluation of community programs is presented. It is based on a systems approach and consists of seven procedural steps: overview, need assessment, goal-setting, resource organization, action, reviews, and outcome statements. Feedback information is used to correct and improve system performance. Two examples of the model in use are given to illustrate both its application and its generality. These concern the management of individual patients in a community-oriented psychiatric ward program and the organization of a comprehensive community development project. The feature common to these applications is the ability of the model to reduce complex endeavors to a few manageable steps, with no loss of comprehensiveness.