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Background: Practitioners who support unaccompanied minors (UAMs) come from different professional backgrounds and often are not appropriately trained to address children's complex mental health needs. This gap informed a training programme across all accommodation centres in Greece. Methods: The aim of the Train-of-Trainer (ToT) national programme was to upskill trainers from 17 organisations to cascade knowledge. Training was interprofessional, trauma-informed and culturally sensitive. A pilot implementation involved 199 practitioners from all disciplines. A sub-sample of 33 practitioners, nine managers and six trainers shared their experiences in focus group discussions, which were analysed through a thematic framework. Results: Participants found that the programme was useful in generating knowledge relevant to children's needs and their roles, addressing the emotional impact of trauma on staff, sharing learning across professional disciplines and being interactive, but systemic support should be put in place for benefits to be sustained. Conclusions: Train-of-Trainer is a resource-effective approach to upskill mixed staff groups across many organisations. This should involve caregivers and staff with limited educational opportunities, while accommodating for different professional needs. Training should be integrated to service budgets, specifications and structures. Plain language summary: Staff who support refugee children without parents come from different backgrounds, and often have limited mental health knowledge and skills. To address this gap, a national programme was established for 17 organisations hosting accommodation centres across Greece. Selected professionals were upskilled as trainers to cascade knowledge to their staff group. Training was based on the understanding of the impact of trauma and children's cultural needs and was provided to interdisciplinary staff groups. In total, 199 staff attended pilot training. Experiences of the training were shared by a sub-group of 33 trained staff, nine managers and six trainers through focus group discussions. These were analysed through a qualitative thematic approach. Key findings included the relevance of new knowledge to children's needs and staff roles, training as a team, using learning methods based on real issues, and supports that should be put in place to ensure that benefits are maintained. Such a model of cascading knowledge and skills can be useful for large numbers of organisations and staff supporting refugee and other vulnerable children. Training should include staff such as caregivers, who may have had limited educational opportunities, while balancing between different staff roles. Training should be integral to all functions of accommodation centres. [ABSTRACT FROM AUTHOR]

Youth with mental health needs face barriers in seeking and accessing help, especially in resource-constrained settings in Majority World Countries. Community engagement is thus important for mental health promotion, particularly in addressing stigma. Engagement can be enhanced by involving peer educators and by relating to intergenerational experiences in the sociocultural context of the community. The aim of this study was to explore how intergenerational experiences and perspectives can inform the co-production of youth-led mental health promotion in a Majority World Country, Pakistan. We recruited 11 families (one grandmother, mother and granddaughter in each family) as advisers from two disadvantaged areas of Karachi, and 14 peer educators. Training for peer educators included seminars, experiential activities, three participatory workshops with family advisers and supervision. A sub-sample of family advisers and peer educators attended four focus groups, and peer educators completed reflective diaries following each activity. Data were integrated and subjected to thematic codebook analysis. The three themes related to enabling and hindering factors towards co-production of mental health promotion, incorporation of intergenerational resilience and cascading knowledge to communities. The findings highlighted potential benefits of youth-led mental health promotion that contextualizes intergenerational experiences for those communities. Peer educator roles should be supported by training, and mental health promotion should be integrated within local service systems. [ABSTRACT FROM AUTHOR]

The digital divide is especially pertinent in Majority World Countries (MWCs), and this was exacerbated greatly by the pandemic. Tackling the digital divide underpins the work of Human-- Computer Interaction for Development (HCI4D) and remains an important global endeavour. Our project aimed to understand how children and young people (CYP) in MWC coped during the pandemic and how technology played a role. Voices of CYP were complemented by those of their parents and professionals with whom CYP interacted regularly. Our empirical study involved 73 CYP and 76 adults from Brazil, Kenya, Pakistan, South Africa, and Turkey. Qualitative data from diaries, drawings and focus groups were analysed thematically. Four major themes were identified -- 'access', 'usage', 'risk', and 'future Among others, some intriguing findings were that CYP acutely felt the peer pressure on ICT ownership and tended to direct frustration at parents, who grappled with their untenable roles as gatekeepers to digital worlds. Implications for addressing the digital divide include long-term strategies to improve infrastructures and mobilise community-based collaborative efforts and enhance digital literacy. [ABSTRACT FROM AUTHOR]

Several risk factors for children's mental health and wellness have been established. These are compounded by inequalities, especially in Majority World Countries (MWC). As evidence is largely based on adult reports, we aimed to capture children's experiences of risk across five MWC resource-constrained settings (Brazil, Pakistan, Turkey, Kenya, and South Africa) during the height of COVID-19 pandemic. Participants included 36 children aged 8–10 years and 37 young people aged 14–16 years. We employed a thematic design using a participatory methodological approach in collecting data through diary entries, drawings, posters, focus groups discussions, and child-led interviews with elders. Two researchers integrated and analysed the data set through a thematic codebook framework. Three identified themes related to exacerbation of existing risks, disruption or loss of protective factors, and lack of access to structural supports. Children linked risk factors along their socioecology. The findings have implications in actively involving children as social actors in determining and addressing risk for mental health and wellness through child-centred and multi-sectoral policy and interventions. [ABSTRACT FROM AUTHOR]

Drawing on integrated data from focus groups and diary entries, we explored the impact of the COVID‐19 pandemic on child well‐being for children from five Majority World Countries. We focus on the disruptions the pandemic caused, the adjustments made in response to these, and children's vision of a post‐pandemic world. Underlying children's experiences of loss, boredom and concerns about educational progress, was an awareness of systemic inequalities that disadvantaged them or others in their community. Findings have implications on capturing children's voices through introspective and dialogical approaches that transcend cultures and for the development of preventive and responsive interventions during crises. [ABSTRACT FROM AUTHOR]

There is limited evidence on the cultural appropriateness of first-stage psychosocial interventions for youth with mental health problems who experience conflict and disadvantage in low- and middle-income countries (LMIC). To evaluate the feasibility of such an intervention (Writing for Recovery – WfR) among youth with emerging emotional problems following internal displacement in Kenya. Fifty-four youth aged 14–17 years were randomly allocated to a six-session intervention or a waiting list control group. They completed measures of stressful life events; post-traumatic stress, depressive and anxiety symptoms; quality of life; and free text on their experience of the intervention. Young participants reported high levels of trauma exposure and emotional problems. The intervention was perceived as flexible and culturally acceptable, with reported short-term impact. This was found to have promising post-intervention effect in reducing post-traumatic stress, but not depressive or anxiety symptoms; and in enhancing quality of life scores. Similar psychosocial interventions that can be delivered by paraprofessionals are important for resource-constrained LMIC settings, but need to be integrated within a comprehensive scaled service model. [ABSTRACT FROM AUTHOR]

Digital technology offers opportunities for child mental health capacity building, which is a priority for Majority World Countries (MWC). The aim of this study was to explore the experiences and perspectives of professionals from different disciplines in Turkey (n =12) and Pakistan (n =15), who had completed a two-module digital trauma-informed programme on enhancing practice skills and instigating systemic changes. Interview data were analysed through a coding thematic approach. Participants especially valued the interdisciplinary and holistic approach of the training, and its proposed scaled service model. Digital training, particularly in blended format, can enhance reach and capacity in MWC low-resource settings. [ABSTRACT FROM AUTHOR]

• Child mental health interventions in Majority World Countries should be contextualized to local sociocultural needs. • Integration to existing psychosocial support can enhance uptake and maximize limited resources. • A Train-of-Trainer cascade approach has potential to widen reach and sustain impact. • Communities should be involved in the whole design and implementation process. This study evaluated the process of integrating child and youth mental health to existing psychosocial support in disadvantaged South African communities. Four child practitioners of the host organization attended a Train-of-Trainer programme. They subsequently co-produced an intervention informed by a service transformation framework along five service domains. Implementation involved 368 community participants. A sub-sample of 43 participants were engaged in focus groups on their experiences. Data were analysed through thematic analysis. Established themes were inter-linked and transcended the five intervention domains. Engagement and conceptualization of mental health through awareness were viewed as pre-requisites to application of new knowledge. This should be supported by systemic changes, predominantly community mobilization and integrated care. Knowledge transfer involving collaboration between services and communities would enable sustainability of impact. The findings led to the formulation of a Theory of Change. Integration of child and youth mental health through a cascade approach that actively involves communities in co-production and delivery can enhance service provision in resource-constrained Majority World contexts. [ABSTRACT FROM AUTHOR]

The objective was to establish how stakeholders in low- and middle-income countries (LMIC) conceptualize child mental health impact. Semi-structured interviews were conducted with 18 stakeholders from disadvantaged urban communities in Kenya, South Africa, Turkey and Brazil. Participants represented education, welfare and health care agencies; as well as community and religious groups. Data were analysed through a thematic approach and three related themes were identified. Impact was defined as a process of change, with child-centred outcomes and measures that were broader than mental health symptoms improvement. Beneficiaries were identified at child, family, community and service level. Participants wished to see strategies that ensured sustainability of impact, namely child mental health policy, stakeholder engagement, interdisciplinary working, and capacity-building for all stakeholder groups. Child mental health service transformation in LMIC, especially in areas of deprivation, needs to build on existing resources and strengths by co-producing psychosocial outcomes with a range of professional and community stakeholders. Impact on children's mental wellbeing can be achieved through a co-ordinated strategy that involves designated policy, capacity-building, and interdisciplinary networks with meaningful community involvement. [ABSTRACT FROM AUTHOR]

Despite the evidence on the role of parental factors, especially attachment relationships, in mediating complex trauma experienced by refugee children, there is limited evidence on the use of attachment‐based interventions. The aim of this study was to explore the feasibility of adapting such an intervention, group theraplay, for refugee children in Turkey. Fifteen child–parent dyads participated, and completed measures on attachment relationships, child mental health and parenting strategies. Children engaged with the intervention, whilst it proved more difficult to involve parents regularly. There was a significant improvement in children's post‐traumatic stress and other common mental health symptoms, as well as parent‐rated attachment relationship difficulties. Attachment‐based modalities using play, activities and games can be particularly useful for children and families with cultural and language challenges. Therapeutic interventions for refugee children and families should be integrated with other types of support within a multimodal service approach. [ABSTRACT FROM AUTHOR]

We consider how the prolonged, complex and uncertain aftermath of the COVID‐19 crisis will present challenges and opportunities for counselling and psychotherapy. Increased mental strain on populations, individuals and professionals is likely to be compounded by further constraints in therapeutic resources. Nevertheless, emerging needs and priorities will offer ground for systems thinking in linking the application of a range of therapeutic frameworks, theories to address global challenges, integration of counselling and psychotherapy into new sectors, service models for the most vulnerable, use of digital approaches, support mechanisms for professionals and interdisciplinary research. [ABSTRACT FROM AUTHOR]

Purpose: The purpose of this paper is to develop a child psychosocial framework among stakeholders in areas of disadvantage in three low- and middle-income countries (LMIC), i.e. Kenya, Turkey and Brazil, and to capture their proposed recommendations through action plans according to this framework. Design/methodology/approach: Workshops were facilitated with a total of 54 participants from different disciplines. The framework addressed safety and child-centredness, quality of care, resilience-building in schools and communities, enhancing competencies within existing roles, counselling and psychological interventions, and access to mental health services. Stakeholders' perspectives were captured through a participatory action procedure. Findings: The emerging 33 categories across the framework dimensions and the three sites led to four overarching and inter-linked themes. These related to community awareness; empowerment and "mobilization" of children, young people and families; inter-agency policy and practice; and capacity-building on skills acquisition at different levels. Research limitations/implications: The next stage in this service research should be full implementation and evaluation in different LMIC contexts. Practical implications: It is feasible to implement such a child psychosocial framework in contexts of conflict and disadvantage, and in the absence of specialist mental health services. Active stakeholder engagement and co-production should be central to the next phase of service transformation in LMIC. Originality/value: This study captured the views and experiences of stakeholders in LMIC areas of disadvantage, and demonstrated their readiness to establish interdisciplinary networks and re-focus existing services. [ABSTRACT FROM AUTHOR]

Children in low- and middle-income countries (LMICs) have high levels of unmet mental health needs. Barriers include stigma, lack of culturally appropriate interventions, and limited resources and staff competencies. This article describes the capacity-building activities of a global child mental health program that particularly targets vulnerable children and communities, with emerging supporting evidence. Capacity-building includes complementary psychoeducational materials, interdisciplinary practice-focused training, digital learning, and a manualized service transformation program. [ABSTRACT FROM AUTHOR]

Background: Unaccompanied refugee minors present with disproportionately high prevalence of emotional and psychological morbidities. However, their utilization of mental health services has been shown to be significantly poorer than the indigenous population of the country they seek asylum in. Despite this, there is limited research exploring their perspectives on the barriers they face. Aims: This research aims to understand unaccompanied refugee minors' and their carers' perceptions of the barriers to utilize mental health services and to explore issues perceived to be related to poor engagement with services. Methods: Semi-structured interviews with 15 unaccompanied refugee minors and their carers were conducted. This was to elicit their views, perceptions and beliefs based on their experience of receiving treatment from a specialist mental health service in the UK. Results: Thematic analysis was used and the findings were categorised into two broad themes; the participants' perceptions of the intervention and perceptions of the professionals. Salient aspects of these are discussed. Conclusions: The findings have potential to stimulate further research into gaining a better understanding of the barriers these young people face in accessing help, and may contribute to developing services that are more efficient in engaging this vulnerable group and meeting their specific needs. [ABSTRACT FROM AUTHOR]

Background: Since 2010, the numbers of refugees have increased and around half are under 18 years of age. It is known that experience of organised violence, displacement and resettlement increases the risk for psychiatric disorders and psychosocial impairment. This review integrates recent research into the risk and protective factors for psychopathology with service and treatment issues. Methods: We draw on and critically evaluate key systematic reviews in the selected areas, innovative robust studies and relevant government reports. Results: Many refugee children show resilience and function well, even in the face of substantial adversities. The most robust findings for psychopathology are that PTSD, and posttraumatic and depressive symptoms are found at higher prevalence in those who have been exposed to war experiences. Their severity may decrease over time with resettlement, but PTSD in the most exposed may show higher continuity. More severe psychiatric disorders including psychosis may also occur. Service delivery needs to take into account socioeconomic and cultural influences but, given the high level of unmet need even in high‐income countries, stepped care delivery is required. The evaluation of psychological interventions, often delivered in group settings, suggests that they can be effective for many distressed children; however, for the more impaired, a greater range of disorder‐specific therapies will be required. Conclusions: Child and adolescent mental health clinicians and service providers need to be aware of the specific needs of this population and systems for service delivery. There are significant knowledge gaps in understanding risk and vulnerability, service delivery and treatment effectiveness. [ABSTRACT FROM AUTHOR]

Children exposed to multiple adversities are at high risk of developing complex mental health and related problems, which are more likely to be met through integrated interprofessional working. Combining the expertise of different practitioners for interprofessional care is especially pertinent in low- and middle-income countries (LMIC) in the absence of specialist resources. The aim of this study was to work with practitioners who deliver care to vulnerable children in six LMIC (Turkey, Pakistan, Indonesia, Kenya, Rwanda, and Brazil) to understand their perspectives on the content of an interprofessional training programme in building resilience for these children. Seventeen participants from different professional backgrounds, who were in contact with vulnerable children were interviewed. A thematic analytic framework was used. Four themes were identified, which were the benefits of a tiered approach to training, challenges and limitations, perceived impact, and recommendations for future training. The findings indicate the importance of co-ordinated policy, service, and training development in an interprofessional context to maximize resources; the need for cultural adaptation of skilled-based training and interventions; and the usefulness of new technologies to enhance accessibility and reduce costs in LMIC. [ABSTRACT FROM AUTHOR]

Low‐ and middle‐income countries (LMIC) are faced with disproportionately high levels of unmet child mental health needs. This study explored through interviews the perspectives of 17 inter‐agency service stakeholders from Brazil, Indonesia, Kenya, Pakistan, Rwanda and Turkey on existing supports and challenges. Four themes emerged on the holistic nature of children's mental health needs linked with disadvantage; limited resources and skilled workforce; stigma; and strategies for future implementation, including awareness, parental engagement, skills‐based programmes and cultural adaptation. Stakeholder input is essential in conceptualising, developing and evaluating culturally appropriate interventions for vulnerable children in LMIC. [ABSTRACT FROM AUTHOR]

Background: Child mental health services and related agencies are faced with an increasing challenge in responding to the influx of refugee children around the world. There is strong evidence on the prevalence and complexity of these children's mental health problems and broader needs. Aims: To review the research literature on risk and protective factors, and associated mental health interventions for refugee children. Methods: Peer‐reviewed studies were included for the period 2004–2017; if they included refugee, asylum‐seeking or internally displaced children under 18 years; and adopted a quantitative design. Vulnerability and protective factors for refugee children were considered in this context, followed by the respective types of interventions at pre‐, peri‐ and postmigration stage, and across high‐ and low‐/middle‐income countries. Eighty‐two peer‐reviewed studies fulfilled the selection criteria. Results: The existing body of literature is largely based on identifying risk factors among children with mental health problems and predominantly designing trauma‐focused interventions to reduce their symptomatic distress. Recent research and services have gradually shifted to a broader and dynamic resilience‐building approach based on ecological theory, that is at child, family, school, community and societal level. There is increasing evidence for the implementation and effectiveness of multimodal interventions targeting all these levels, despite the methodological constraints in their evaluation. Conclusions: In high‐income countries, child mental health services need to collaborate with all agencies in contact with refugee children, establish joint care pathways, and integrate trauma‐focused interventions with family and community approaches. In low‐ and middle‐income countries, where specialist resources are sparse, resilience‐building should aim at maximising and upskilling existing capacity. A six‐dimensional psychosocial model that applies to other children who experience complex trauma is proposed. [ABSTRACT FROM AUTHOR]

Aim: The present study aimed to determine the social support levels perceived by Palestinian adults with disabilities and to compare the data with socio-demographic variables. Method: N=416 participants (n=263 men, n=53 women); ages ranged from 19-70 years (M= 33.56 years) were selected randomly from the databases of two NGOs for people with disabilities. Instruments: Demographic data were collected via questionnaire for gender, age, class, and place of residence and attitudes and perceptions about social adaptation, life status, social role, self-esteem and self-concept were via the Social Support Scale. Results: The most commonly reported items in the Social Support Scale included feeling the need for security (69.6%), not feeling satisfied about quality of life (39%), understanding the demands of a new life (53.3%), feeling the need for love and social recognition (69.4%), and being aware of personal potential and ability (69.4%). Men with disabilities reported higher self-esteem than women with disabilities. Those who had no income had less social adaptation, less life status, less social role, and less self-concept. Conclusion and clinical implications: The importance of focus for improving the social support, self-esteem, and well-being of disabled Palestinian adults and families. Self-esteem enhancement interventions offered in this context might well have an increased effect when combined with the other services available through independent living. Culturally sensitive interventions need to be developed to further enable people in all strata of the social hierarchy to understand their own worth and bring about changes in their lives and communities. Psychosocial interventions can play a useful role in supporting awareness and the development of accurate and positive appraisals of the self, alongside the process of adjusting to life of disabled people. [ABSTRACT FROM AUTHOR]

Rationale Self-harm in young people is of significant clinical concern. Multiple psychological, social and clinical factors contribute to self-harm, but it remains a poorly understood phenomenon with limited effective treatment options. Objective To explore young women's experience of self-harm in the context of interpersonal stressors and supports. Method Fourteen adolescent females (13–18 years) who had self-harmed in the last six months completed semi-structured interviews about self-harm and supports. Interpretative phenomenological analysis was undertaken. Results Themes identified were: 1) Arguments and worries about family breakdown; 2) Unhelpful parental response when self-harm discovered and impact on seeking support; 3) Ongoing parental support; 4) Long-term peer victimization/bullying as a backdrop to self-harm; 5) Mutual support and reactive support from friends (and instances of a lack of support); 6) Emotions shaped by others (shame, regret and feeling ‘stupid to self-harm’); and 7) ‘Empty promises’ - feeling personally let down by clinical services. These themes were organised under two broad meta-themes (psychosocial stressors, psychosocial supports). Two additional interconnected meta-themes were identified: Difficulties talking about self-harm and distress; and Impact on help-seeking. Conclusion Parents and peers play a key role in both precipitating self-harm and in supporting young people who self-harm. The identified themes, and the apparent inter-relationships between them, illustrate the complexity of self-harm experienced in the context of interpersonal difficulties, supports, and emotions. These results have implications for improving support from both informal and clinical sources. [ABSTRACT FROM AUTHOR]

To date, research on refugee mental health has mainly focused on understanding the absence of psychopathology rather than on their well-being and associated positive aspects. The aim of this study was to examine the role of resilience, hope, belongingness, and social support in predicting satisfaction with life and flourishing among 361 minority Syrian refugees living in Iraq (age range = 18–60 years, mean = 32.57, SD = 10.05). Participants completed the Brief Resilience Scale, Adult Hope Scale, Multidimensional Scale of Perceived Social Support Scale, General Belongingness Scale, Satisfaction With Life Scale, and Flourishing Scale. Males reported significantly higher levels of resilience, belongingness, and flourishing compared to females. Demographic variables (age, gender, and economic level), resilience, hope, belongingness, and social support were correlated with life satisfaction and flourishing scores. While controlling for sociodemographic characteristics, resilience and hope were associated with life satisfaction and flourishing scores. However, belongingness and social support were only associated with flourishing scores. The findings suggest that equipping refugees with positive psychological resources could promote increased levels of life satisfaction and flourishing and thus enhance preventive psychosocial programs. [ABSTRACT FROM AUTHOR]

Background Despite growing evidence on the extent of child mental health problems in low-middle-income countries, the gap between need and provision remains high. Previous research in high income countries has demonstrated that evidence-based interventions can be scaled-up through community consultation, particularly by engaging key stakeholders. Aims This study aimed to explore community stakeholders' views on children's mental health needs and culturally acceptable interventions in Kenya, to ascertain how to integrate global service standards with culturally-specific expectations. Methods Focus groups were conducted with community stakeholders (seven young people 14-17 years, seven parents, nine teachers and 11 other professionals). These participants were recruited from an urban community of internally displaced and disadvantaged families in Nakuru. Results Results indicated that Kenya faced similar challenges in meeting mental health needs as in other countries, including economic constraints, limited knowledge, stigma and systemic issues, but that these were manifested in culturally specific ways that were linked to societal and professional's attitudes and local context. Conclusions Stakeholders' views are important in informing the planning, delivery and evaluation of interventions. However, for such interventions to be sustained, a clear therapeutic framework, evidence-base and sociocultural adaptation are likely to be important factors. [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]

• Youth mental health support in Global South Countries should be concurrently addressed at the inter-linked relational, systems and structural levels. • Forming meaningful connections are central to accessing such support. • Youth with mental health lived experience should be incorporated in the planning, implementation and evaluation of services. Youth mental health support and services vary across sociocultural contexts. It is important to capture the perspectives of youth with lived experiences for planning needs-led interventions and services, especially in Global South Countries (GSC), with limited specialist resources and representative literature. The aim was to establish how youth with lived experiences of anxiety and depression viewed external support in different countries, and how these views were juxtaposed with those of professionals. We involved 121 youth aged 14–24 years and 62 professionals from different disciplines in eight countries, predominantly from the Global South. Two youth and one professional focus group was facilitated in each country. The data were analysed through a codebook thematic approach. Youth across all countries largely valued informal support from family, peers and community, whilst those from GSC had limited access to structural support. They related lived experiences to therapeutic engagement and processes, in contrast with professionals who focused on outcomes and service delivery. Mental health awareness and integration of interventions with social support were considered essential by both youth and professionals, especially in disadvantaged communities. The mental health needs of youth in disadvantaged GSC communities can be best met through multi-modal interventions addressing these needs across their socioecology and positioned within a stepped care model. Youth with lived experiences should be involved in service planning, implementation and monitoring. [ABSTRACT FROM AUTHOR]

Background Recent policies recommend effective joint working between health and education; however, the views of service users are underrepresented, particularly opinions of young children. Method The project was operational from 2005-2008 when interviews were conducted with parents and children. The children were attending CAMHS for mental health and educational difficulties. Results Results indicated that they had a positive view of multiagency working. They consider that joint working is limited by a number of problems and make recommendations for improvement. Conclusions Findings indicate that more effective communication between agencies is needed and this should be provided for parents in an accessible language. This has implications for training professionals together. [ABSTRACT FROM AUTHOR]

Background Despite the available epidemiological evidence on the prevalence of mental health problems in childhood and adolescence, there is limited knowledge on whether there are differences in the level of need and service utilisation by young ethnic minority groups. Methods Adolescents of 13-15 years from nine schools in two English cities in which children of Indian ethnicity were over-represented (n=2900), completed rating scales on different types of mental health problems, contacts with services and informal supports. Results Indian adolescents scored significantly lower on general mental health and depression symptoms. They were also less likely than White adolescents to selfreport having mental health problems, even for a similar level of need. Among those with mental health scores within the clinical range, Indian adolescents were less likely to have visited specialist services. Instead, they were more likely to first approach family members, teachers or general practitioners. Conclusions Rather than a blanket approach being applied to policy and service planning to meet the needs of diverse communities of young people, more specific evidence needs to be gained about patterns of referrals of minority groups and their strategy of accessing supportive adults. [ABSTRACT FROM AUTHOR]

Background Schools play an important role in promoting child mental health, but little is known about the approaches they undertake. Methods A scoping survey in England, involving 599 primary and 137 secondary schools. Results Although two thirds of school approaches focused on all pupils, these were predominantly reactive, rather than preventive interventions. They were also largely not evidence-based, were instead based on a plan while open to adaptation. Gaps were identified in teacher training and support. Conclusions The findings have implications on the use of preventive versus reactive approaches, staff training and consultation, use of evidence-based practice in schools and joint care pathways. [ABSTRACT FROM AUTHOR]

The importance of joint working between educational and child mental health professionals is well documented but there are numerous challenges and only limited training models. While the evidence base and training programmes for educationalists regarding child mental health is growing, training mental health professionals about education is more limited. This study presents the views of 36 child mental health and education professionals from four service localities in England regarding their experiences of joint working and perceptions of training, including a preliminary evaluation of a training programme designed to bridge this gap. The findings indicate that participants perceived that a degree of knowledge in education matters is important, and reported that this could be acquired through the development of relationships with educational professionals, setting up link posts and joint training; they also described challenges related to building experience and to resource constraints. Participants were generally positive about the training package and reported that there was a clear training need in this area. [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]

Children in public care and other vulnerable young groups (homeless, adopted, refugees) are increasingly becoming the focus of policy and service planning. There is strong evidence that all these client populations have high rates of mental health problems which are closely associated with other needs. We also have good knowledge on the factors that predispose individuals to and maintain mental health problems, as well as on the reasons for their not easily accessing and engaging with services. There is less evidence on the effectiveness of interventions or service models, although some interesting patterns are beginning to emerge. These include the need for inter-agency commissioning, clear care pathways, designated provision, applied therapeutic interventions, training for carers and frontline practitioners, and multi modal programmes. This paper discusses these issues, as well as ways forward, both for systems with relatively well developed child mental health services and for low-income countries. Service quality can be greatly strengthened by international collaboration on policy, practice and research networks, training and research. [ABSTRACT FROM PUBLISHER]

Previous research has provided evidence on the effectiveness of CBT in the symptomatic improvement of children with obsessive–compulsive disorders. There is also increasing recognition of the importance of involving parents and families in treatment. The aim of this study was to evaluate the short-term effectiveness of such an intervention that promoted family strengths [(quality of life therapy (QoLT)] for mothers of children with obsessive–compulsive disorders (OCD). The sample consisted of 40 children with OCD and their mothers, who had been referred to clinics in Esfahan city in Iran. Mothers were randomly allocated to an experimental (QoLT) and waiting list control group. Mothers participated in eight QoLT group sessions over 4 weeks. QoLT incorporated CBT techniques in managing OCD symptoms. Measures were completed pre- and post-intervention by both groups. Children completed the Yale–Brown obsession compulsion scale for Children, the Revised children’s manifest anxiety scale, and the brief multidimensional student’s life satisfaction scale; mothers completed the quality of life inventory (QoLI). QoLT was associated with decrease in OCD and anxiety symptoms and increase in children’s satisfaction in the global, family and environment domains, as well as with increased QoLI scores in their mothers. Parenting interventions like QoLT can complement individual modalities such as CBT in the presence of family-related difficulties. This can be particularly applicable in countries and settings with limited resources and high stigma of child mental health problems. [ABSTRACT FROM AUTHOR]

The aim of this study was to explore what professionals working in a child and adolescent mental health service (CAMHS) thought of provision of mental health services to diverse groups and what their training needs might be. Semi-structured interviews were undertaken and audiotaped with 17 CAMHS professionals. The tapes were transcribed and the data analysed using thematic analysis. The findings show no discernible pattern between different professional groups within the sample, although this is limited by the sample size and is perhaps not surprising given the common professional context. Just over half the participants perceived cultural diversity as equating with ethnic diversity. Staff thought diversity influenced service provision through access; communication; perceptions that different communities hold about mental health; perceptions that different communities hold about mental health services; and service factors. Staff were not clear about their own training needs and identified that training to date had not been entirely satisfactory. Staff openness may present an ideal opportunity to start dialogues with staff and community groups about how best services can be provided for an increasing diverse population of children and families. [ABSTRACT FROM AUTHOR]

Background: Many studies have described associations between adult psychiatric disorder among adults and their biographic, socio-demographic and social capital characteristics. Fewer studies have focused on children, and most of these have looked at structural indicators of the neighbourhood. Our objective was to examine one aspect of social capital – perceived neighbourhood trust and safety in relation to childhood psychopathology. Methods: Data on childhood psychopathology and perceived neighbourhood trust and safety were obtained on 3,340 11 to 16-year-olds included in a large survey of the mental health carried out in 426 postal sectors in Great Britain. Data were collected on biographic and socio-demographic characteristics of the child and the family, measures of social capital and neighbourhood prosperity. We entered all these variables into a logistic regression analysis to establish the strength of association between perceived neighbourhood trust and safety separately for emotional and conduct disorders. Results: Children's perception of their neighbourhoods in terms of the trustworthiness or honesty of the people who live there or feeling safe walking alone had a strong association with childhood psychopathology, particularly emotional disorders, rather than the nature of the neighbourhood itself. Children's behaviour, however, such as going to the park or shops alone, did not vary by measures of childhood psychopathology. Conclusions: Regeneration of less prosperous neighbourhoods is likely to increase children's positive perceptions of trust, honesty and safety which in turn can have a positive effect on their mental health. [ABSTRACT FROM AUTHOR]

The aim of this study was to explore Gujarati parents' and adolescents' perceptions of child and adolescent mental health services and how these should be improved to best meet their needs. Semi-structured qualitative interviews were carried out with 15 parents and 15 young people, recruited from a community centre. Overall, the quality of the service appeared more important than its responsiveness to culture or ethnicity for both young people and their parents. These findings indicate the need for further evidence and debate on whether Black and ethnic minority families should be treated as though they are a homogenous group. [ABSTRACT FROM AUTHOR]

This study examined the relationship between coping, mental health and goal achievement among homeless mothers. Seventy-two women took part and 44 were re-interviewed 4 months later. The Family Crisis Oriented Personal Evaluation Scales (F-COPES) were used to identify their coping strategies at the time of homelessness; the General Health Questionnaire (GHQ) measured mental health problems; and a semi-structured questionnaire identified their goals. Outcome measures at follow-up were goal achievement and mental health. A variety of coping strategies were used, with some differences ascertained according to reason for homelessness and age of respondent. Lower use of problem-focussed coping was associated with poorer mental health at the time of homelessness. Mental health problems improved over time, but levels of psychopathology remained high at follow-up. Most women had achieved their primary goal of resettlement, and this was associated with use of problem-focussed coping. Lower use of problem-focussed coping, in particular, acquiring social support, was associated with continuation of mental health problems at follow-up, however the greatest predictor of mental health at follow-up was mental health status whilst homeless. Despite exposure to major stressors and poor mental health, mothers experiencing homelessness can maintain their ability to cope effectively, in order to achieve their goals. Copyright © 2007 John Wiley & Sons, Ltd. [ABSTRACT FROM AUTHOR]

The article discusses the use of the terms culture and cultural competence, including the evaluation of child and adolescent mental health services to diverse population groups. The evidence on cultural diversity education is explored, which is considered as a potential intervention alongside workforce issues and quality improvement strategies.

The aim of this study was to evaluate the short-term impact of two types of family support services (FSS) for children with behavioural problems (N = 51 and 49 respectively). These were compared with children (N = 40) matched for presenting problems and referred to specialist CAMHS in a locality without FSS. Pre and postintervention measures were the Health of the Nation Outcome Scales (HoNOSCA), the Strengths and Difficulties Questionnaire (SDQ), and a service utilization checklist. Although all three groups were associated with decrease of child behavioural scores, the two family support services provided an earlier response and resulted in significantly higher reduction of HoNOSCA and SDQ scores. The two FSS types implemented different `levels' of interventions, as FSS- B resulted in a more favourable short-term outcome and appeared to operate more closely to specialist services, while FSS-A appeared to adopt a more preventive role. Family support services have an important role within a comprehensive child mental health service, but the specificity of their interventions for different target client groups requires further investigation. [ABSTRACT FROM AUTHOR]

Background: Parental and child psychiatric disorders have been found to be associated, and this association can be mediated by other psychosocial variables, including parenting attitudes and strategies. As most previous studies included clinical samples, the purpose of this study was to establish the relationship between parental psychopathology and parenting strategies with child psychiatric disorders in a national survey population.Methods: The sample included 10,438 children of 5-15 years and their parents, from representative UK households. Families were assessed on child psychiatric diagnosis, parental psychopathology, family functioning, and socioeconomic status. Parenting strategies included using rewards, physical and non-physical punishments towards their child.Findings: Parental psychopathology scores (OR 3.99, 95% CI 3.13-5.09) and non-physical punishment (OR 1.50, 95% CI 1.27-1.76) were associated with child psychiatric disorders. This association was particularly prominent among children with conduct disorders: parental psychopathology scores (OR 3.13, 95% CI 2.28-4.30) and non-physical punishment (OR 3.19, 95% CI 2.55-3.97). Absence of child psychopathology was associated with a combination of rewarding and non-punitive parenting strategies.Conclusions: Although parents in the general population may be using less physical strategies than in the past, non-physical punishment is strongly related to mental health problems in children. Enhancement of positive parenting through universal and targeted interventions is an important preventive strategy. [ABSTRACT FROM AUTHOR]

The aim of this study was to evaluate the short-term impact of a group crisis intervention for children aged 9–15 years from five refugee camps in the Gaza Strip during ongoing war conflict. Children were selected if they reported moderate to severe posttraumatic stress reactions, and were allocated to group intervention (N=47) encouraging expression of experiences and emotions through storytelling, drawing, free play and role-play; education about symptoms (N=22); or no intervention (N=42). Children completed the CPTSD-RI and the CDI pre- and post-intervention. No significant impact of the group intervention was established on children’s posttraumatic or depressive symptoms. Possible explanations of the findings are discussed, including the continuing exposure to trauma and the non-active nature of the intervention. [ABSTRACT FROM AUTHOR]

Postnatal depression has been associated with mother–infant relationship difficulties, but there has been less research in clinical populations. This study aims to identify characteristics of reported mother–infant relationship difficulties in mothers with postnatal depression who had been referred to a tertiary Mother and Baby Service. Forty-one mothers with postnatal depression completed self-report and interview measures with regards to their mental state, social adversity, and perceptions on their relationship with their infants. Almost one-third of mothers (31.7%) reported severe difficulties, including rejection of the infant and maternal pathological anger. A low birth weight and maternal dissatisfaction towards their social role were found to be significantly related to perceived mother–infant interaction difficulties. Self-reports correlated satisfactorily with interview schedules. A significant proportion of mothers reported difficulties in relating to their infants which can be reliably identified by means of the self-report measures used. Copyright © 2004 John Wiley & Sons, Ltd. [ABSTRACT FROM AUTHOR]

This qualitative study investigated the need for transitional mental health services for young people aged 16 - 19 years in a health district, as perceived by professionals from mental health, social, education and non-statutory services. Semi-structured interviews with 39 managers and practitioners who planned or provided services for this age range, from a wide range of agencies, explored issues related to older adolescents' needs, service communication, transfer arrangements, current gaps, and recommendations. Interviews were transcribed verbatim and themes emerged according to grounded theory. The four identified themes, with 21 categories, were: (i) older adolescents have multi-faceted needs, (ii) statutory mental health services are not geared towards this age group, (iii) communication between services is variable, and (iv) there are no formal transfer arrangements from child to adult services. The findings support the need for specialist transitional services, and the adoption of an interprofessional service model incorporating education, social services and nonstatutory agencies. [ABSTRACT FROM AUTHOR]

Background Children with conduct disorders and their families come into contact with a range of community and specialist agencies. Methods The aim of this study was to establish the lifetime service utilisation rates among children with conduct disorders from the Great Britain National Study (N = 10,438), and to examine the association between comorbid disorders, family and social factors, and service utilisation. The Development and Well-Being Assessment, a service checklist, and a battery of family and social functioning measures were used. Results The weighted prevalence of oppositional and conduct disorders was 5.4 %. Within this group (N =403), 241 (59.8%) had conduct disorder only 79 (19.6%) comorbid emotional, 72 (17.9%) comorbid hyperkinetic, and 11(2.7%) comorbid emotional and hyperkinetic disorders. These subgroups were compared on service utilisation with children with other psychiatric disorders (N=351). Children with conduct disorders had significantly higher lifetime rates of utilisation of social and educational services than children with other psychiatric disorders. Contact with primary health, specialist health, and educational services was significantly associated with comorbid physical and psychiatric disorders. In contrast, contact with social services was associated with family discord and social sector tenancy. Conclusions The findings are discussed in the context of organisation and coordination of health, other statutory, and non-statutory services, also taking into account previous research on interventions for children with conduct disorders and their families. [ABSTRACT FROM AUTHOR]

This article describes the development of the primary mental health worker (PMHW) role within Child and Adolescent Mental Health Services (CAMHS) within the UK, and focuses on services in Leicester, Leicestershire and Rutland, an area with a general population of 900,000. The concept behind thc PMHW role is described and the application of this to practice is outlined. The role consists of consultation, liaison, direct work and training. The described primary mental health team comprises 13 PMHWs and is an integral part of a comprehensive CAMHS. Its aim is to support and enable primary care professionals in their work with mental health issues in children and families, thus promoting early recognition and management of child mental health problems and filtering appropriate referrals for specialist CAMHS intervention. [ABSTRACT FROM AUTHOR]

Background: Children and mothers who have suffered domestic or neighbourhood violence constitute a high risk group, although it has not been clear whether their mental health needs are specifically related to the type of violence. This paper reports on the prevalence of mental health problems in homeless parents and children who have experienced domestic and neighbourhood violence and their access to social support networks. Methods: Three groups of families who had become homeless were compared: those experiencing domestic violence (48 with 75 children), victims of neighbourhood violence (14 with 29 children), and those who became homeless for other reasons (31 with 54 children). Mothers completed a service use semi-structured interview, the Strengths and Difficulties Questionnaire, the General - Health Questionnaire, the Family Support Scales, and the SF-36 Health Status Questionnaire. Results: Levels of psychiatric morbidity were high in the group experiencing domestic violence (35.7% in children and 21.9% in mothers) and higher still in those who were victims of neighbourhood violence (52.2% in children and 50% in mothers). Levels of social support were found to be an important factor, particularly in relation to professional support and support from other family members, as they predicted both child and maternal psychopathology. Conclusions: Mental health interventions for victims of domestic and neighbourhood violence should be integrated with community programmes of social reintegration. Mental health professionals should work in close collaboration with Housing Departments, Social Services, Education and the Police. [ABSTRACT FROM AUTHOR]

An inter-agency training programme in child and adolescent mental health for primary care staff has been developed in a UK area serving a general population of 900 000. This was initiated with a training needs and resources analysis across all the joint strategy partners (three local authorities, one health authority and the voluntary sector). Training is provided to inter-agency groups of professionals in 12 localities. To date, 150 staff have been through the two-day introductory/foundation course, which is complemented by three subsequent training days on the assessment and management of children and families. Staff evaluation ratings are presented. On the whole, primary healthcare staff rated their awareness of mental health issues and their knowledge of staff roles within child mental health services significantly higher, in contrast with education staff who rated these components lower. Inter-agency training has been achieved with some difficulties needing to be overcome, but the participants' feedback indicates that the expected output is beginning to be realized. The implications of the project are discussed. [ABSTRACT FROM AUTHOR]

Presents books about child psychology. 'Adopted Children Speaking,' by C. Thomas and V. Beckford with N. Lowe and M. Murch; 'We Are a Family: Sibling Relationships in Placement and Beyond,' edited by A. Mullender; 'The Handbook of Child and Adolescent Psychotherapy. Psychoanalytic Approaches,' edited by Monica Lanyado and Ann Horne.

Presents the psychological characteristics of Greek young offenders attending a probation service in Great Britain. Identification of main offenses; Percentage of recurrent offending; Evidence of a high rate of borderline to mild learning disability.