1
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Parikh N, Faulkner A, Hadji-Michael M, Heyman I, Murphy T, McAllister E. Group-based parent training programme for children with neurological conditions: a feasibility study. Arch Dis Child 2024; 109:138-143. [PMID: 37898503 DOI: 10.1136/archdischild-2023-326174] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/03/2023] [Accepted: 09/30/2023] [Indexed: 10/30/2023]
Abstract
OBJECTIVE AND DESIGN This study aimed to determine the feasibility and effectiveness of a parent training programme for parents of children with neurological conditions and behaviours that challenge. SETTING Child and adolescent mental health service within a specialist children's hospital. PARTICIPANTS Parents of 31 children with neurological conditions and behaviours that challenge. INTERVENTIONS Parents attended a 6-week evidence-based behavioural parenting programme delivered in a group format, either face-to-face or remote. MAIN OUTCOME MEASURES Feasibility was determined by attendance rates. Effectiveness was analysed primarily using parent-reported measures of child behaviour (Strengths and Difficulties Questionnaire, Paediatric Quality of Life and Goal-Based Outcomes). Secondary measures of parental well-being were also reported (Brief Parental Self-Efficacy Scale, Depression Anxiety Stress Scale Short Form and Parental Sense of Competence). Paired t-tests or Wilcoxon rank-sum tests were conducted to analyse differences preintervention and postintervention. RESULTS The attendance rates for the face-to-face and remote groups were 80% and 79%, respectively. Medium to large effect sizes were reported for most measures of child behaviour and parental well-being. There were statistically significant improvements found postintervention in children's behaviour (p=0.014), quality of life (p<0.001), goal-based outcomes (p<0.001), parental self-efficacy (p<0.001) and parental anxiety (p=0.030). Anecdotal feedback showed that parents indicated the group format was acceptable. CONCLUSIONS The group parenting intervention for parents of children with heterogeneous neurological conditions and behaviours that challenge appears feasible and effective in improving child behaviour and parental well-being.
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Affiliation(s)
- Nimmi Parikh
- Great Ormond Street Hospital for Children, London, UK
| | | | | | - Isobel Heyman
- Great Ormond Street Hospital for Children, London, UK
| | - Tara Murphy
- Great Ormond Street Hospital for Children, London, UK
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2
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Catanzano M, Bennett SD, Fifield K, Xu L, Sanderson C, Coughtrey AE, Kerry E, Liang H, Heyman I, Shafran R. Efficient Sufficiency: A qualitative evaluation of a 1 year pilot study of young people and parents accessing a mental health drop-in centre in a paediatric hospital. Child Care Health Dev 2023; 49:332-345. [PMID: 36006804 PMCID: PMC10087919 DOI: 10.1111/cch.13051] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/01/2021] [Revised: 08/19/2022] [Accepted: 08/20/2022] [Indexed: 11/30/2022]
Abstract
BACKGROUND Children and young people with long-term physical health conditions (LTC) are known to have higher levels of co-morbid mental health problems than medically healthy children. Evidence-based treatments for mental health problems are effective in children who also have an LTC. This study aimed to explore the factors associated with participants' perceived acceptability and impact of a transdiagnostic mental health centre offering brief psychological assessment and treatment for children and young people and/or their families with mental health needs in the context of long term physical conditions. METHODS One-hundred twenty-eight patients attending the drop-in centre were invited to participate. Overall, 35 participated (31 parents/carers; 4 children and young people) in semi-structured interviews (either in person or by phone) exploring their experience of the centre. Interviews were audio-recorded, transcribed and checked. Framework analysis was then conducted on all transcripts. RESULTS Overall, participants found the drop-in centre highly acceptable and reported a positive experience. Reasons for this varied but broadly focused around four themes: (1) efficient sufficiency; (2) autonomy; (3) fusion of process and content factors and (4) (dis)parities of esteems and 'seeing both sides of the coin'. CONCLUSIONS Participants found the intervention acceptable. A mental health drop-in centre in a paediatric hospital appears to be a positive and valued adjunct to supplement existing mental health services.
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Affiliation(s)
- Matteo Catanzano
- UCL Great Ormond Street Institute of Child Health, London, UK.,Great Ormond Street Hospital NHS Foundation Trust, London, UK
| | - Sophie D Bennett
- UCL Great Ormond Street Institute of Child Health, London, UK.,Great Ormond Street Hospital NHS Foundation Trust, London, UK
| | - Kate Fifield
- UCL Great Ormond Street Institute of Child Health, London, UK.,Great Ormond Street Hospital NHS Foundation Trust, London, UK
| | - Laila Xu
- UCL Great Ormond Street Institute of Child Health, London, UK
| | - Charlotte Sanderson
- UCL Great Ormond Street Institute of Child Health, London, UK.,Great Ormond Street Hospital NHS Foundation Trust, London, UK
| | - Anna E Coughtrey
- UCL Great Ormond Street Institute of Child Health, London, UK.,Great Ormond Street Hospital NHS Foundation Trust, London, UK
| | - Ellie Kerry
- UCL Great Ormond Street Institute of Child Health, London, UK.,Great Ormond Street Hospital NHS Foundation Trust, London, UK
| | - Holan Liang
- UCL Great Ormond Street Institute of Child Health, London, UK.,Great Ormond Street Hospital NHS Foundation Trust, London, UK
| | - Isobel Heyman
- UCL Great Ormond Street Institute of Child Health, London, UK.,Great Ormond Street Hospital NHS Foundation Trust, London, UK
| | - Roz Shafran
- UCL Great Ormond Street Institute of Child Health, London, UK.,Great Ormond Street Hospital NHS Foundation Trust, London, UK
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3
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Bennett SD, Kerry E, Fifield K, Ching BCF, Catanzano M, Liang H, Heyman I, Coughtrey AE, Sanderson C, Rojas N, Shafran R. A drop‐in centre for treating mental health problems in children with chronic illness: Outcomes for parents and their relationship with child outcomes. JCPP ADVANCES 2021. [DOI: 10.1002/jcv2.12046] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Affiliation(s)
- Sophie D. Bennett
- UCL Great Ormond Street Institute of Child Health London UK
- Great Ormond Street Hospital for Children NHS Foundation Trust London UK
| | - Eleanor Kerry
- UCL Great Ormond Street Institute of Child Health London UK
- Great Ormond Street Hospital for Children NHS Foundation Trust London UK
| | - Kate Fifield
- UCL Great Ormond Street Institute of Child Health London UK
- Great Ormond Street Hospital for Children NHS Foundation Trust London UK
| | - Brian C. F. Ching
- UCL Great Ormond Street Institute of Child Health London UK
- Great Ormond Street Hospital for Children NHS Foundation Trust London UK
| | - Matteo Catanzano
- UCL Great Ormond Street Institute of Child Health London UK
- Great Ormond Street Hospital for Children NHS Foundation Trust London UK
| | - Holan Liang
- UCL Great Ormond Street Institute of Child Health London UK
- Great Ormond Street Hospital for Children NHS Foundation Trust London UK
| | - Isobel Heyman
- UCL Great Ormond Street Institute of Child Health London UK
- Great Ormond Street Hospital for Children NHS Foundation Trust London UK
| | - Anna E. Coughtrey
- UCL Great Ormond Street Institute of Child Health London UK
- Great Ormond Street Hospital for Children NHS Foundation Trust London UK
| | - Charlotte Sanderson
- UCL Great Ormond Street Institute of Child Health London UK
- Great Ormond Street Hospital for Children NHS Foundation Trust London UK
| | - Natalia Rojas
- UCL Great Ormond Street Institute of Child Health London UK
- Great Ormond Street Hospital for Children NHS Foundation Trust London UK
| | - Roz Shafran
- UCL Great Ormond Street Institute of Child Health London UK
- Great Ormond Street Hospital for Children NHS Foundation Trust London UK
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4
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Bennett S, Heyman I, Varadkar S, Coughtrey A, Walji F, Shafran R. Guided Self-help Teletherapy for Behavioural Difficulties in Children with Epilepsy. J Clin Psychol Med Settings 2021; 28:477-490. [PMID: 33740166 PMCID: PMC8458180 DOI: 10.1007/s10880-021-09768-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/25/2021] [Indexed: 12/02/2022]
Abstract
Behavioural difficulties impact greatly upon quality of life for children with chronic illness and their families but are often not identified or adequately treated, possibly due to the separation of physical and mental health services. This case study describes the content and outcomes of guided self-help teletherapy for behavioural difficulties in a child with epilepsy and complex needs using an evidence-based behavioural parenting protocol delivered within a paediatric hospital setting. Behavioural difficulties and progress towards the family's self-identified goals were monitored at each session. Validated measures of mental health and quality of life in children were completed before and after intervention and satisfaction was measured at the end of treatment. Measures demonstrated clear progress towards the family's goals and reduction in weekly ratings of behavioural difficulties. This case demonstrates that a guided self-help teletherapy approach delivered from within the paediatric setting may be one way of meeting unmet need.
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Affiliation(s)
- Sophie Bennett
- UCL Great Ormond Street Institute of Child Health, University College London, 30 Guilford Street, London, UK. .,Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK.
| | - Isobel Heyman
- UCL Great Ormond Street Institute of Child Health, University College London, 30 Guilford Street, London, UK.,Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK
| | - Sophia Varadkar
- UCL Great Ormond Street Institute of Child Health, University College London, 30 Guilford Street, London, UK.,Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK
| | - Anna Coughtrey
- UCL Great Ormond Street Institute of Child Health, University College London, 30 Guilford Street, London, UK.,Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK
| | - Fahreen Walji
- UCL Great Ormond Street Institute of Child Health, University College London, 30 Guilford Street, London, UK.,Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK
| | - Roz Shafran
- UCL Great Ormond Street Institute of Child Health, University College London, 30 Guilford Street, London, UK.,Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK
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5
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Bennett SD, Heyman I, Coughtrey AE, Varadkar S, Stephenson T, Shafran R. Telephone-guided self-help for mental health difficulties in neurological conditions: a randomised pilot trial. Arch Dis Child 2021; 106:862-867. [PMID: 33402326 DOI: 10.1136/archdischild-2019-318577] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/22/2019] [Revised: 12/04/2020] [Accepted: 12/09/2020] [Indexed: 11/04/2022]
Abstract
OBJECTIVE This study aimed to conduct a randomised pilot trial to assess the feasibility of a randomised controlled trial (RCT) to investigate the effect of telephone-guided self-help for the treatment of mental health difficulties in children with neurological conditions. DESIGN Preliminary RCT. The primary outcome measure was the Strengths and Difficulties Questionnaire. SETTING Neurology clinics in a national tertiary paediatric hospital. PATIENTS Young people attending neurology clinics who met criteria for mental health difficulties according to the Development and Wellbeing Assessment. INTERVENTIONS 12 weeks of telephone-guided self-help based on a modular approach to psychological therapy for children delivered to children and/or their parents (n=17; eight males; mean age 12.04 years, SD=3.34) or a waiting list for telephone-guided self-help with no additional intervention over 12 weeks (n=17; nine males; mean age 10.53 years, SD=3.14). RESULTS 124 participants completed the DAWBA, and 34 children and young people were entered into the trial. 65% of those randomised to the intervention arm completed the full intervention, and the intervention was acceptable to those completing it. However, there were significant problems related to lack of data completion (38% data loss for primary outcome measure), choice of control comparator and outcome measures. Due to significant loss of data at follow-up, the effect size findings are considered unreliable. CONCLUSIONS Further feasibility work should be conducted to improve data completeness before progression to a definitive trial of guided self-help for mental health problems in children with neurological conditions can be recommended. TRIAL REGISTRATION NUMBER ISRCTN21184717.
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Affiliation(s)
- Sophie D Bennett
- UCL Great Ormond Street Institute of Child Health, UCL, London, UK
| | - Isobel Heyman
- UCL Great Ormond Street Institute of Child Health, UCL, London, UK.,Great Ormond Street Hospital For Children NHS Foundation Trust, London, UK
| | - Anna E Coughtrey
- UCL Great Ormond Street Institute of Child Health, UCL, London, UK.,Great Ormond Street Hospital For Children NHS Foundation Trust, London, UK
| | - Sophia Varadkar
- UCL Great Ormond Street Institute of Child Health, UCL, London, UK.,Great Ormond Street Hospital For Children NHS Foundation Trust, London, UK
| | | | | | - Roz Shafran
- UCL Great Ormond Street Institute of Child Health, UCL, London, UK
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6
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Balcombe L, De Leo D. Digital Mental Health Challenges and the Horizon Ahead for Solutions. JMIR Ment Health 2021; 8:e26811. [PMID: 33779570 PMCID: PMC8077937 DOI: 10.2196/26811] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/28/2020] [Revised: 02/06/2021] [Accepted: 02/27/2021] [Indexed: 01/19/2023] Open
Abstract
The demand outstripping supply of mental health resources during the COVID-19 pandemic presents opportunities for digital technology tools to fill this new gap and, in the process, demonstrate capabilities to increase their effectiveness and efficiency. However, technology-enabled services have faced challenges in being sustainably implemented despite showing promising outcomes in efficacy trials since the early 2000s. The ongoing failure of these implementations has been addressed in reconceptualized models and frameworks, along with various efforts to branch out among disparate developers and clinical researchers to provide them with a key for furthering evaluative research. However, the limitations of traditional research methods in dealing with the complexities of mental health care warrant a diversified approach. The crux of the challenges of digital mental health implementation is the efficacy and evaluation of existing studies. Web-based interventions are increasingly used during the pandemic, allowing for affordable access to psychological therapies. However, a lagging infrastructure and skill base has limited the application of digital solutions in mental health care. Methodologies need to be converged owing to the rapid development of digital technologies that have outpaced the evaluation of rigorous digital mental health interventions and strategies to prevent mental illness. The functions and implications of human-computer interaction require a better understanding to overcome engagement barriers, especially with predictive technologies. Explainable artificial intelligence is being incorporated into digital mental health implementation to obtain positive and responsible outcomes. Investment in digital platforms and associated apps for real-time screening, tracking, and treatment offer the promise of cost-effectiveness in vulnerable populations. Although machine learning has been limited by study conduct and reporting methods, the increasing use of unstructured data has strengthened its potential. Early evidence suggests that the advantages outweigh the disadvantages of incrementing such technology. The limitations of an evidence-based approach require better integration of decision support tools to guide policymakers with digital mental health implementation. There is a complex range of issues with effectiveness, equity, access, and ethics (eg, privacy, confidentiality, fairness, transparency, reproducibility, and accountability), which warrant resolution. Evidence-informed policies, development of eminent digital products and services, and skills to use and maintain these solutions are required. Studies need to focus on developing digital platforms with explainable artificial intelligence-based apps to enhance resilience and guide the treatment decisions of mental health practitioners. Investments in digital mental health should ensure their safety and workability. End users should encourage the use of innovative methods to encourage developers to effectively evaluate their products and services and to render them a worthwhile investment. Technology-enabled services in a hybrid model of care are most likely to be effective (eg, specialists using these services among vulnerable, at-risk populations but not severe cases of mental ill health).
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Affiliation(s)
- Luke Balcombe
- Australian Institute for Suicide Research and Prevention, Griffith University, Brisbane, Australia
| | - Diego De Leo
- Australian Institute for Suicide Research and Prevention, Griffith University, Brisbane, Australia
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7
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Bennett SD, Au C, Byford S, Chorpita B, Coughtrey AE, Cross JH, Dalrymple E, Fonagy P, Ford T, Heyman I, Lewins A, Moss-Morris R, Reilly C, Xu L, Shafran R. Feasibility of telephone-delivered therapy for common mental health difficulties embedded in pediatric epilepsy clinics. Epilepsy Behav 2021; 116:107743. [PMID: 33556861 DOI: 10.1016/j.yebeh.2020.107743] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/02/2020] [Revised: 12/21/2020] [Accepted: 12/21/2020] [Indexed: 02/07/2023]
Abstract
BACKGROUND Mental and physical health treatment should be delivered together for children and young people with epilepsy. Training healthcare professionals (HCPs) in epilepsy services to deliver mental health interventions is an important way to facilitate integrated care. OBJECTIVE To determine the feasibility of remotely delivered assessment and psychological treatment for mental health difficulties delivered by HCPs in pediatric epilepsy clinics with limited formal training in psychological interventions. We hypothesized that it would be (i) feasible to train HCPs to deliver the psychological intervention and (ii) that participants receiving the psychological therapy would report reductions in symptoms of mental health difficulties including anxiety, depression, and behavior difficulties and improve quality of life. METHODS Thirty-four children and young people with epilepsy who had impairing symptoms of a common mental health difficulty (anxiety, depression, disruptive behavior, and/or trauma) were allocated to receive 6 months of a modular cognitive behavioral intervention delivered by a HCP with limited formal psychological therapy experience. Thirteen HCPs were trained in delivery of the intervention. Healthcare professional competence was assessed in a two-stage process. Parent-reported measures of mental health symptoms and quality of life were completed at baseline and following the intervention. Paired t-tests were used to analyze changes in symptoms over time. RESULTS All thirteen HCPs who participated in the training were considered competent in therapeutic delivery by the end of the training period. Twenty-three patients completed pre- and post-intervention measures and were included in the analysis. There were statistically significant improvements in: symptoms of mental health problems (p = 0.01; Cohen's d = 0.62), total impact of mental health problems (p = 0.03; Cohen's d = 0.52), anxiety and depression symptoms (p = 0.02; Cohen's d = 0.57) and quality of life (p = 0.01; Cohen's d = 0.57). CONCLUSION A modular cognitive behavioral treatment delivered over the telephone by HCPs with limited experience of psychological therapy was feasible and effective in treating mental health problems in children and young people with epilepsy. Health-related Quality of Life also improved over the duration of treatment. A randomized controlled trial (RCT) is needed to demonstrate efficacy of the intervention.
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Affiliation(s)
- Sophie D Bennett
- Great Ormond Street Hospital for Children NHS Foundation Trust, UK.
| | - Christy Au
- Great Ormond Street Hospital for Children NHS Foundation Trust, UK
| | - Sarah Byford
- Great Ormond Street Hospital for Children NHS Foundation Trust, UK
| | - Bruce Chorpita
- Great Ormond Street Hospital for Children NHS Foundation Trust, UK
| | - Anna E Coughtrey
- Great Ormond Street Hospital for Children NHS Foundation Trust, UK
| | - J Helen Cross
- Great Ormond Street Hospital for Children NHS Foundation Trust, UK
| | - Emma Dalrymple
- Great Ormond Street Hospital for Children NHS Foundation Trust, UK
| | - Peter Fonagy
- Great Ormond Street Hospital for Children NHS Foundation Trust, UK
| | - Tamsin Ford
- Great Ormond Street Hospital for Children NHS Foundation Trust, UK
| | - Isobel Heyman
- Great Ormond Street Hospital for Children NHS Foundation Trust, UK
| | - Amy Lewins
- Great Ormond Street Hospital for Children NHS Foundation Trust, UK
| | - Rona Moss-Morris
- Great Ormond Street Hospital for Children NHS Foundation Trust, UK
| | - Colin Reilly
- Great Ormond Street Hospital for Children NHS Foundation Trust, UK
| | - Laila Xu
- Great Ormond Street Hospital for Children NHS Foundation Trust, UK
| | - Roz Shafran
- Great Ormond Street Hospital for Children NHS Foundation Trust, UK
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8
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Catanzano M, Bennett SD, Kerry E, Liang H, Heyman I, Coughtrey AE, Fifield K, Taylor C, Dalgleish T, Xu L, Shafran R. Evaluation of a mental health drop-in centre offering brief transdiagnostic psychological assessment and treatment for children and adolescents with long-term physical conditions and their families: a single-arm, open, non-randomised trial. EVIDENCE-BASED MENTAL HEALTH 2021; 24:25-32. [PMID: 33243761 PMCID: PMC7958088 DOI: 10.1136/ebmental-2020-300197] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/02/2020] [Revised: 10/24/2020] [Accepted: 10/27/2020] [Indexed: 11/04/2022]
Abstract
BACKGROUND Children and young people with long-term physical conditions have significantly elevated mental health needs. Transdiagnostic, brief psychological interventions have the potential to increase access to evidence-based psychological treatments for patients who attend health services primarily for physical health needs. OBJECTIVE A non-randomised study was conducted to assess the impact of brief, transdiagnostic psychological interventions in children and young people presenting at a drop-in mental health centre in the reception area of a paediatric hospital. METHODS 186 participants attending a transdiagnostic mental health drop-in centre were allocated to assessment and psychological intervention based on a clinical decision-making algorithm. Interventions included signposting, guided self-help based on a modular psychological treatment and referral to the hospital's paediatric psychology service. The primary transdiagnostic mental health outcome measure was the parent-reported Strengths and Difficulties Questionnaire (SDQ), which was given at baseline and 6 months post-baseline. FINDINGS There was a significant positive impact of attending the drop-in mental health centre on the SDQ (Cohen's d=0.22) and on the secondary outcome measure of Paediatric Quality of life (Cohen's d=0.55). CONCLUSIONS A mental health drop-in centre offering brief, transdiagnostic assessment and treatment may reduce emotional and behavioural symptoms and improve quality of life in children and young people with mental health needs in the context of long-term physical conditions. A randomised controlled trial to investigate the specificity of any effects is warranted. CLINICAL IMPLICATIONS Drop-in centres for mental health needs may increase access and have beneficial effects for children and young people with physical conditions.
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Affiliation(s)
- Matteo Catanzano
- UCL Great Ormond Street Institute of Child Health, University College London, London, UK
- Psychological and Mental Health Services, Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK
| | - Sophie D Bennett
- UCL Great Ormond Street Institute of Child Health, University College London, London, UK
- Psychological and Mental Health Services, Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK
| | - Ellie Kerry
- UCL Great Ormond Street Institute of Child Health, University College London, London, UK
- Psychological and Mental Health Services, Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK
| | - Holan Liang
- UCL Great Ormond Street Institute of Child Health, University College London, London, UK
- Psychological and Mental Health Services, Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK
| | - Isobel Heyman
- UCL Great Ormond Street Institute of Child Health, University College London, London, UK
- Psychological and Mental Health Services, Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK
| | - Anna E Coughtrey
- UCL Great Ormond Street Institute of Child Health, University College London, London, UK
- Psychological and Mental Health Services, Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK
| | - Kate Fifield
- UCL Great Ormond Street Institute of Child Health, University College London, London, UK
- Psychological and Mental Health Services, Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK
| | - Chloe Taylor
- UCL Great Ormond Street Institute of Child Health, University College London, London, UK
- Psychological and Mental Health Services, Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK
| | - Tim Dalgleish
- MRC Cognition and Brain Sciences Unit, Cambridge, Cambridgeshire, UK
| | - Laila Xu
- UCL Great Ormond Street Institute of Child Health, University College London, London, UK
| | - Roz Shafran
- UCL Great Ormond Street Institute of Child Health, University College London, London, UK
- Psychological and Mental Health Services, Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK
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9
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Lorentzos MS, Heyman I, Baig BJ, Coughtrey AE, McWilliams A, Dossetor DR, Waugh MC, Evans RA, Hollywood J, Burns J, Menezes MP, Mohammad SS, Grattan-Smith P, Gorman KM, Crowe BHA, Goodman R, Kurian MA, Dale RC. Psychiatric comorbidity is common in dystonia and other movement disorders. Arch Dis Child 2021; 106:62-67. [PMID: 32709686 DOI: 10.1136/archdischild-2020-319541] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/30/2020] [Revised: 06/08/2020] [Accepted: 06/15/2020] [Indexed: 12/26/2022]
Abstract
OBJECTIVE To determine rates of psychiatric comorbidity in a clinical sample of childhood movement disorders (MDs). DESIGN Cohort study. SETTING Tertiary children's hospital MD clinics in Sydney, Australia and London, UK. PATIENTS Cases were children with tic MDs (n=158) and non-tic MDs (n=102), including 66 children with dystonia. Comparison was made with emergency department controls (n=100), neurology controls with peripheral neuropathy or epilepsy (n=37), and community controls (n=10 438). INTERVENTIONS On-line development and well-being assessment which was additionally clinically rated by experienced child psychiatrists. MAIN OUTCOME MEASURES Diagnostic schedule and manual of mental disorders-5 criteria for psychiatric diagnoses. RESULTS Psychiatric comorbidity in the non-tic MD cohort (39.2%) was comparable to the tic cohort (41.8%) (not significant). Psychiatric comorbidity in the non-tic MD cohort was greater than the emergency control group (18%, p<0.0001) and the community cohort (9.5%, p<0.00001), but not the neurology controls (29.7%, p=0.31). Almost half of the patients within the tic cohort with psychiatric comorbidity were receiving medical psychiatric treatment (45.5%) or psychology interventions (43.9%), compared with only 22.5% and 15.0%, respectively, of the non-tic MD cohort with psychiatric comorbidity. CONCLUSIONS Psychiatric comorbidity is common in non-tic MDs such as dystonia. These psychiatric comorbidities appear to be under-recognised and undertreated.
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Affiliation(s)
| | - Isobel Heyman
- Department of Child and Adolescent Mental Health, Great Ormond Street Hospital For Children NHS Foundation Trust, London, UK
| | - Benjamin J Baig
- Department of Child and Adolescent Mental Health, Great Ormond Street Hospital For Children NHS Foundation Trust, London, UK
| | | | - Andrew McWilliams
- Department of Child and Adolescent Mental Health, Great Ormond Street Hospital For Children NHS Foundation Trust, London, UK
| | - David R Dossetor
- Children's Hospital at Westmead, Westmead, New South Wales, Australia
| | - Mary-Clare Waugh
- Kids Rehabilitation Department, The Children's Hospital at Westmead, Sydney, New South Wales, Australia
| | - Ruth A Evans
- Children's Hospital at Westmead, Westmead, New South Wales, Australia
| | - Josie Hollywood
- Department of Child and Adolescent Mental Health, Great Ormond Street Hospital For Children NHS Foundation Trust, London, UK
| | - Joshua Burns
- The University of Sydney, Sydney, New South Wales, Australia
| | - Manoj P Menezes
- Children's Hospital at Westmead, Westmead, New South Wales, Australia
| | | | | | - Kathleen M Gorman
- Department of Neurology and Clinical Neurophysiology, Children's Health Ireland at Temple Street, Dublin, Ireland.,University College Dublin School of Medicine and Medical Science, Dublin, Ireland
| | - Belinda H A Crowe
- The Neurodisability Service, Great Ormond Street Hospital fro Children, London, UK
| | - Robert Goodman
- Child and Adolescent Psychiatry, Institute of Psychiatry, London, UK
| | - Manju A Kurian
- Neurosciences, UCL-Institute of Child Health, London, UK
| | - Russell C Dale
- Children's Hospital at Westmead, Westmead, New South Wales, Australia .,The University of Sydney, Sydney, New South Wales, Australia
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10
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Shafran R, Bennett S, Coughtrey A, Welch A, Walji F, Cross JH, Heyman I, Sibelli A, Smith J, Ross J, Dalrymple E, Varadkar S, Moss-Morris R. Optimising Evidence-Based Psychological Treatment for the Mental Health Needs of Children with Epilepsy: Principles and Methods. Clin Child Fam Psychol Rev 2020; 23:284-295. [PMID: 31965422 PMCID: PMC7192863 DOI: 10.1007/s10567-019-00310-3] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
There are potent evidence-based psychological treatments for youth with mental health needs, yet they are rarely implemented in clinical practice, especially for youth with mental health disorders in the context of chronic physical illness such as epilepsy. Implementation science, the study of the translation of research into practice, can promote the uptake of existing effective interventions in routine clinical practice and aid the sustainable integration of psychological treatments with routine health care. The aim of this report was to use four implementation science methods to develop a version of an existing effective psychological treatment for mental health disorders [the Modular Approach to Treatment of Children with Anxiety, Depression or Conduct Problems (MATCH-ADTC)] for use within paediatric epilepsy services: (a) literature search; (b) iterative focus groups underpinned by normalisation process theory; (c) Plan-Do-Study-Act methods; and (d) qualitative patient interviews. Findings: Three modifications were deemed necessary to facilitate implementation in children with both mental health disorders and epilepsy. These were (a) a universal brief psychoeducational component addressing the relationship between epilepsy and mental health; (b) supplementary, conditionally activated interventions addressing stigma, parental mental health and the transition to adulthood; and (c) additional training and supervision. The intervention needed relatively little alteration for implementation in paediatric epilepsy services. The modified treatment reflected the scientific literature and the views of clinicians and service users. The multi-method approach used in this report can serve as a model for implementation of evidence-based psychological treatments for children with mental health needs in the context of other chronic illnesses.
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Affiliation(s)
- Roz Shafran
- Population, Policy and Practice Research and Teaching Department, University College London Great Ormond Street Institute of Child Health, 30 Guilford Street, London, WC1N 1EH, UK.
- Great Ormond Street Hospital NHS Foundation Trust, Great Ormond Street, London, WC1N 3JH, UK.
| | - Sophie Bennett
- Population, Policy and Practice Research and Teaching Department, University College London Great Ormond Street Institute of Child Health, 30 Guilford Street, London, WC1N 1EH, UK
- Great Ormond Street Hospital NHS Foundation Trust, Great Ormond Street, London, WC1N 3JH, UK
| | - Anna Coughtrey
- Population, Policy and Practice Research and Teaching Department, University College London Great Ormond Street Institute of Child Health, 30 Guilford Street, London, WC1N 1EH, UK
- Great Ormond Street Hospital NHS Foundation Trust, Great Ormond Street, London, WC1N 3JH, UK
| | - Alice Welch
- Population, Policy and Practice Research and Teaching Department, University College London Great Ormond Street Institute of Child Health, 30 Guilford Street, London, WC1N 1EH, UK
- Great Ormond Street Hospital NHS Foundation Trust, Great Ormond Street, London, WC1N 3JH, UK
| | - Fahreen Walji
- Population, Policy and Practice Research and Teaching Department, University College London Great Ormond Street Institute of Child Health, 30 Guilford Street, London, WC1N 1EH, UK
- Great Ormond Street Hospital NHS Foundation Trust, Great Ormond Street, London, WC1N 3JH, UK
| | - J Helen Cross
- Population, Policy and Practice Research and Teaching Department, University College London Great Ormond Street Institute of Child Health, 30 Guilford Street, London, WC1N 1EH, UK
- Great Ormond Street Hospital NHS Foundation Trust, Great Ormond Street, London, WC1N 3JH, UK
| | - Isobel Heyman
- Population, Policy and Practice Research and Teaching Department, University College London Great Ormond Street Institute of Child Health, 30 Guilford Street, London, WC1N 1EH, UK
- Great Ormond Street Hospital NHS Foundation Trust, Great Ormond Street, London, WC1N 3JH, UK
| | - Alice Sibelli
- Health Psychology, Institute of Psychiatry, Psychology and Neuroscience, Kings College London, London, SE1 9RT, UK
| | | | - Jamie Ross
- Department of Primary Care and Population Health, UCL Medical School (Royal Free Campus), University College London, Rowland Hill Street, London, NW3 2PF, UK
| | - Emma Dalrymple
- Population, Policy and Practice Research and Teaching Department, University College London Great Ormond Street Institute of Child Health, 30 Guilford Street, London, WC1N 1EH, UK
| | - Sophia Varadkar
- Great Ormond Street Hospital NHS Foundation Trust, Great Ormond Street, London, WC1N 3JH, UK
| | - Rona Moss-Morris
- Health Psychology, Institute of Psychiatry, Psychology and Neuroscience, Kings College London, London, SE1 9RT, UK
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Bennett SD, Heyman I, Coughtrey AE, Buszewicz M, Byford S, Dore CJ, Fonagy P, Ford T, Moss-Morris R, Stephenson T, Varadkar S, Walker E, Shafran R. Assessing feasibility of routine identification tools for mental health disorder in neurology clinics. Arch Dis Child 2019; 104:1161-1166. [PMID: 31079075 DOI: 10.1136/archdischild-2018-316595] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/23/2018] [Revised: 02/14/2019] [Accepted: 03/07/2019] [Indexed: 11/04/2022]
Abstract
OBJECTIVE We aimed to test the feasibility of using an online parent-completed diagnostic assessment for detecting common mental health disorders in children attending neurology clinics. The assessment does not require intervention by a mental health professional or additional time in the clinic appointment. SETTING Two parallel and related screening studies were undertaken: Study 1: Tertiary paediatric neurology clinics. Study 2: Secondary and tertiary paediatric neurology clinics. PATIENTS Study 1: 406 Young people aged 7-18 attending paediatric neurology clinics. Study 2: 225 Young people aged 3-18 attending paediatric epilepsy clinics. INTERVENTIONS Parents completed online versions of the Strengths and Difficulties Questionnaire (SDQ) and Development and Well-being Assessment (DAWBA). MAIN OUTCOME MEASURES We investigated: the willingness of families to complete the measures, proportion identified as having mental health disorders, time taken to complete the measures and acceptability to families and clinicians. RESULTS The mean total difficulties score of those that had completed the SDQ fell in the 'high' and 'very high' ranges. 60% and 70% of the DAWBAS completed met criteria for at least one DSM-IV disorder in study 1 and 2 respectively. 98% of the parents reported that the screening methods used were acceptable.
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Affiliation(s)
| | - Isobel Heyman
- UCL Great Ormond Street Institute of Child Health, London, UK.,Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK
| | - Anna E Coughtrey
- UCL Great Ormond Street Institute of Child Health, London, UK.,Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK
| | - Marta Buszewicz
- Research Department of Primary Care and Population Health, University College London, London, UK
| | - Sarah Byford
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Caroline J Dore
- Comprehensive Clinical Trials Unit, University College London, London, UK
| | - Peter Fonagy
- Research Department of Clinical, Educational and Health Psychology, University College London, London, UK
| | - Tamsin Ford
- University of Exeter Medical School, University of Exeter, Exeter, UK
| | - Rona Moss-Morris
- Department of Psychology, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
| | | | - Sophia Varadkar
- UCL Great Ormond Street Institute of Child Health, London, UK.,Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK
| | - Erin Walker
- Patient Insight and Involvement, UCLPartners, London, UK
| | - Roz Shafran
- UCL Great Ormond Street Institute of Child Health, London, UK
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