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Clinical Update: Child and Adolescent Behavioral Health Care in Community Systems of Care. J Am Acad Child Adolesc Psychiatry 2022; 62:367-384. [PMID: 35690302 DOI: 10.1016/j.jaac.2022.06.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/02/2022] [Accepted: 06/01/2022] [Indexed: 11/28/2022]
Abstract
OBJECTIVE The objective of this Clinical Update is to review the principles, structures, processes, and outcomes of community systems of care as they pertain to the delivery of behavioral health care to children and adolescents METHOD: A search of the literature on this topic from 2002 was initially conducted in 2016 and repeated in 2019 and 2021, yielding 1,604 English-language citations. These citations were supplemented by references suggested by topic experts and identified through Web searches, increasing the yield to 1,684 total citations, of which 1,184 were unduplicated. After sequential review by Update authors at title/abstract and then full-text levels, the citations were winnowed to 156 based on relevance to the topic. RESULTS The systems of care approach, arising in the 1980s, expanded child and adolescent behavioral health care from the core services of psychotherapy, medication management, inpatient psychiatric services, and residential treatment to include home- and community-based treatment and support services; promotion, prevention, and early intervention programs; and specialized services for very young children and youth and young adults of transition age. These services and supports are delivered by a large multidisciplinary workforce and are governed by key principles, including a biopsychosocial case conceptualization; family-driven, youth-guided, strengths-based, and trauma-informed care. Services in the least restrictive setting; continuity of care across transitions; a public health framework for service delivery; promotion of wellness and resilience; and elimination of health disparities. Challenges to systems of care implementation include funding availability, workforce shortages, deficiencies in cross-systems collaboration, and variability in insurance coverage. Although controlled studies have failed to provide convincing evidence of favorable outcomes from the whole systems of care approach, uncontrolled research has demonstrated increased access to care, positive clinical and functional outcomes, improved family functioning, and reductions in costs, particularly when research is focused on specific behavioral health problems, specific interventions such as Wraparound care, or highly specified groups of youth. CONCLUSION Health professionals who are educated in the systems of care approach can improve access to and quality of behavioral health care for children and adolescents with behavioral health needs.
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Wilson C, Parke S, VanDeusen TC, Millard H, Qayyum Z, Kim HJ. Systems of Care for Transitional-Age Youth With Severe Mental Illness. Psychiatr Ann 2022. [DOI: 10.3928/00485713-20220527-01] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Lohr WD, Jawad K, Feygin Y, Le J, Creel L, Pasquenza N, Williams PG, Jones VF, Myers J, Davis DW. Antipsychotic Medications for Low-Income Preschoolers: Long Duration and Psychotropic Medication Polypharmacy. Psychiatr Serv 2022; 73:510-517. [PMID: 34470507 DOI: 10.1176/appi.ps.202000673] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
OBJECTIVE This study aimed to evaluate prescribing patterns of antipsychotic medication and factors that predict duration of use among low-income, preschool-age children. METHODS State Medicaid claims from 2012 to 2017 were used to identify antipsychotic medication use for children <6 years old. ICD-9 and ICD-10 codes were used to describe child diagnoses. Descriptive and multivariable analyses were used to determine patterns of antipsychotic medication use and factors that predicted duration of use. RESULTS In 2012, 316 children <6 years of age started an antipsychotic medication in a southeastern state. Most were non-Hispanic White (N=202, 64%) and boys (N=231, 73%). Diagnoses included attention-deficit hyperactivity disorder (N=288, 91%), neurodevelopmental disorders (N=208, 66%), anxiety and trauma-related diagnoses (N=202, 64%), and autism spectrum disorders (ASDs) (N=137, 43%). The mean±SD duration of exposure to antipsychotic medication for children in the cohort was 2.6±1.7 years, but 86 children (27%) had >4 years of exposure. Almost one-third (N=97, 31%) received polypharmacy of four or more medication classes, and 42% (N=131) received metabolic screening. Being male, being in foster care, and having a diagnosis of ASD or disruptive mood dysregulation disorder were significantly associated with duration of use of antipsychotic medications; race-ethnicity was not significantly associated with duration of use. Emergency department visits (N=277, 88%) and inpatient hospitalizations (N=107, 34%) were observed during the study period. CONCLUSIONS Many preschoolers received antipsychotic medications for substantial periods. Further research is needed to identify evidence-based practices to reduce medication use and improve outcomes.
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Affiliation(s)
- W David Lohr
- Department of Pediatrics, University of Louisville School of Medicine, Louisville, Kentucky (Lohr, Jawad, Feygin, Le, Pasquenza, Williams, Jones, Myers, Davis); Department of Health Management and System Sciences, University of Louisville School of Public Health and Information Science, Louisville, Kentucky (Creel)
| | - Kahir Jawad
- Department of Pediatrics, University of Louisville School of Medicine, Louisville, Kentucky (Lohr, Jawad, Feygin, Le, Pasquenza, Williams, Jones, Myers, Davis); Department of Health Management and System Sciences, University of Louisville School of Public Health and Information Science, Louisville, Kentucky (Creel)
| | - Yana Feygin
- Department of Pediatrics, University of Louisville School of Medicine, Louisville, Kentucky (Lohr, Jawad, Feygin, Le, Pasquenza, Williams, Jones, Myers, Davis); Department of Health Management and System Sciences, University of Louisville School of Public Health and Information Science, Louisville, Kentucky (Creel)
| | - Jennifer Le
- Department of Pediatrics, University of Louisville School of Medicine, Louisville, Kentucky (Lohr, Jawad, Feygin, Le, Pasquenza, Williams, Jones, Myers, Davis); Department of Health Management and System Sciences, University of Louisville School of Public Health and Information Science, Louisville, Kentucky (Creel)
| | - Liza Creel
- Department of Pediatrics, University of Louisville School of Medicine, Louisville, Kentucky (Lohr, Jawad, Feygin, Le, Pasquenza, Williams, Jones, Myers, Davis); Department of Health Management and System Sciences, University of Louisville School of Public Health and Information Science, Louisville, Kentucky (Creel)
| | - Natalie Pasquenza
- Department of Pediatrics, University of Louisville School of Medicine, Louisville, Kentucky (Lohr, Jawad, Feygin, Le, Pasquenza, Williams, Jones, Myers, Davis); Department of Health Management and System Sciences, University of Louisville School of Public Health and Information Science, Louisville, Kentucky (Creel)
| | - P Gail Williams
- Department of Pediatrics, University of Louisville School of Medicine, Louisville, Kentucky (Lohr, Jawad, Feygin, Le, Pasquenza, Williams, Jones, Myers, Davis); Department of Health Management and System Sciences, University of Louisville School of Public Health and Information Science, Louisville, Kentucky (Creel)
| | - V Faye Jones
- Department of Pediatrics, University of Louisville School of Medicine, Louisville, Kentucky (Lohr, Jawad, Feygin, Le, Pasquenza, Williams, Jones, Myers, Davis); Department of Health Management and System Sciences, University of Louisville School of Public Health and Information Science, Louisville, Kentucky (Creel)
| | - John Myers
- Department of Pediatrics, University of Louisville School of Medicine, Louisville, Kentucky (Lohr, Jawad, Feygin, Le, Pasquenza, Williams, Jones, Myers, Davis); Department of Health Management and System Sciences, University of Louisville School of Public Health and Information Science, Louisville, Kentucky (Creel)
| | - Deborah Winders Davis
- Department of Pediatrics, University of Louisville School of Medicine, Louisville, Kentucky (Lohr, Jawad, Feygin, Le, Pasquenza, Williams, Jones, Myers, Davis); Department of Health Management and System Sciences, University of Louisville School of Public Health and Information Science, Louisville, Kentucky (Creel)
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Alarcón RD, Vargas-Murga H, Caballero-Peralta J, Cutipé-Cárdenas Y. Community Psychiatry in a Latin American Context: Perú as a Case Example. ADOLESCENT PSYCHIATRY 2020. [DOI: 10.2174/2210676610666200317155858] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Background:
Historical and conceptual issues related to community psychiatry as
an innovative approach to clinical assistance across the world, precede a more or less detailed
examination of its presence, role and current accomplishments in Latin America, particularly
related to child and adolescent subpopulations. Information about transition processes
from the traditional hospital-centered model to the community-based approach, applicable
mental health policies, levels of implementation and quality of the available reports in
different countries, are duly evaluated.
Objective:
Within an understanding of the broader Latin American context, the paper describes
the situation in Perú, a country considered representative of the Low and Middle Income
(LMIC) group in the subcontinent.
Methods:
The situation in Perú is presented with particular emphasis on a recently established
community-based mental health centers program across its territory.
Results:
This description includes consideration of variables such as personal, family and
identity empowerment, a focus on integrated care, and clinical outcomes and community relations.
The development of community mental health centers across Perú is described.
Conclusion:
Adolescents represent the unique future of socio-culturally diverse Latin
American countries, and must be the target population of well-conceived, cohesive community
mental health policies and programs. The importance of political will to promote community
health centers that provide adolescents access to services is critical.
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Affiliation(s)
- Renato D. Alarcón
- Department of Psychiatry, Mayo Clinic College of Medicine, Rochester, MN, United States
| | - Horacio Vargas-Murga
- Professor of Psychiatry, Chief, Psychiatry Section, School of Medicine, Universidad Peruana Cayetano Heredia; Staff Psychiatrist, National Institute of Mental Health, Lima, Peru
| | - July Caballero-Peralta
- Graduate School Faculty member, Child and Adolescent Psychiatry, School of Medicine, Universidad Peruana Cayetano Heredia; Staff Psychiatrist, Mental Health Division, Ministry of Health, Lima, Peru
| | - Yuri Cutipé-Cárdenas
- Graduate School Faculty member, Child and Adolescent Psychiatry, School of Medicine, Universidad Peruana Cayetano Heredia; Director, Mental Health Division, Ministry of Health, Lima, Peru
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Leyenaar JK, McLaren JL. Healthcare Quality for Children and Adolescents with Suicidality Admitted to Acute Care Hospitals in the United States. J Hosp Med 2018; 13:795-796. [PMID: 30484777 DOI: 10.12788/jhm.3092] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Affiliation(s)
- JoAnna K Leyenaar
- Department of Pediatrics and The Dartmouth Institute For Health Policy and Clinical Practice, Geisel School of Medicine at Dartmouth, Lebanon, New Hampshire. USA.
| | - Jennifer L McLaren
- Department of Psychiatry and The Dartmouth Institute For Health Policy and Clinical Practice, Geisel School of Medicine at Dartmouth, Lebanon, New Hampshire. USA
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A Learning Collaborative Approach to Improve Mental Health Service Delivery in Pediatric Primary Care. Pediatr Qual Saf 2018; 3:e119. [PMID: 31334451 PMCID: PMC6581475 DOI: 10.1097/pq9.0000000000000119] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2017] [Accepted: 09/27/2018] [Indexed: 12/28/2022] Open
Abstract
Supplemental Digital Content is available in the text. Background: Pediatric primary care practitioners (PPCPs) report inadequate training in the care of children with common mental health conditions. Although additional training is needed, system changes are also necessary to support improvements in care. Methods: We developed the Building Mental Wellness Learning Collaborative to assist PPCPs in delivering better mental health services in primary care by targeting 5 focus areas: mental health promotion; early identification and screening; practitioner skills; collaboration and community linkages; and medication management. Aims were developed for each area. Results: Twenty-one practices and 50 practitioners completed the collaborative in 2 seven-month waves. For mental health promotion, ≥85% of charts showed documentation in 3 of 4 preselected areas. For early identification/screening, screening increased, but the ≥85% goal was not met. For practitioner skills, a ≥20% increase in the proportion of children/youth ≥1 visits for anxiety or depression was achieved, from 0.70% of children/youth in the 12 months preintervention to 1.09% children/youth in the 12 months after. For collaboration/linkages, mental health referral completion was unchanged and below the 60% goal. For medication use, a ≥15% increase in selective serotonin reuptake inhibitor prescribing by Building Mental Wellness (BMW) practitioners was achieved from 0.72% children/youth with office visits pre-BMW to 0.92% post. Prescribing did not decrease for atypical antipsychotic medication use or for psychotropic medication use in children younger than 6 years, although there was a trend toward more appropriate prescribing. Conclusions: The BMW Learning Collaborative was effective in helping PPCPs implement certain aspects of a comprehensive approach to the delivery of mental health services in primary care.
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Paul M, O’Hara L, Tah P, Street C, Maras A, Ouakil DP, Santosh P, Signorini G, Singh SP, Tuomainen H, McNicholas F. A systematic review of the literature on ethical aspects of transitional care between child- and adult-orientated health services. BMC Med Ethics 2018; 19:73. [PMID: 30021635 PMCID: PMC6052672 DOI: 10.1186/s12910-018-0276-3] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2017] [Accepted: 05/02/2018] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Healthcare policy and academic literature have promoted improving the transitional care of young people leaving child and adolescent mental health services (CAMHS). Despite the availability of guidance on good practice, there seems to be no readily accessible, coherent ethical analysis of transition. The ethical principles of non-maleficence, beneficence, justice and respect for autonomy can be used to justify the need for further enquiry into the ethical pros and cons of this drive to improve transitional care. The objective of this systematic review was therefore to systematically search for existing ethical literature on child- to adult-orientated health service transitions and to critically appraise and collate the literature, whether empirical or normative. METHODS A wide range of bioethics, biomedical and legal databases, grey literature and bioethics journals were searched. Ancestral and forward searches of identified papers were undertaken. Key words related to transition, adolescence and young adulthood, ethics, law and health. The timeframe was January 2000 to at least March 2016. Titles, abstracts and, where necessary, full articles were screened and duplicates removed. All included articles were critically appraised and a narrative synthesis produced. RESULTS Eighty two thousand four hundred eighty one titles were screened, from which 96 abstracts were checked. Forty seven full documents were scrutinised, leading to inclusion of two papers. Ancestral and forward searches yielded four further articles. In total, one commentary, three qualitative empirical studies and two clinical ethics papers were found. All focused on young people with complex care needs and disabilities. The three empirical papers had methodological flaws. The two ethical papers were written from a clinical ethics context rather than using a bioethical format. No literature identified specifically addressed the ethical challenges of balancing the delivery of transitional care to those who need it and the risk of pathologizing transient and self-limited distress and dysfunction, which may be normal during adolescence. CONCLUSIONS There is very little research on ethical aspects of transitional care. Most existing studies come from services for young people with complex care needs and disabilities. There is much scope for improvement in the amount and quality of empirical research and ethical analysis in this area.
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Affiliation(s)
- Moli Paul
- Warwick Medical School, University of Warwick, Coventry, CV4 7AL UK
- Stratford CAMHS, Coventry and Warwickshire Partnership Trust, Stratford Healthcare, Arden St, Stratford upon Avon, CV34 6NQ UK
| | - Lesley O’Hara
- Saint John of God Research Foundation clg, Stillorgan, Co. Dublin, Republic of Ireland
| | - Priya Tah
- Warwick Medical School, University of Warwick, Coventry, CV4 7AL UK
| | - Cathy Street
- Warwick Medical School, University of Warwick, Coventry, CV4 7AL UK
| | - Athanasios Maras
- Yulius Academie, Centrum voor Wetenschappelijk Onderzoek, Innovatie en Opleidingen, Dennenhout 1, 2994 GC Barendrecht, Netherlands
| | - Diane Purper Ouakil
- CHU Montpellier, Médecine Psychologique de l’Enfant et de l’Adolescent (MPEA1), Hôpital Saint Eloi, 80 avenue Augustin Fliche, 34295 Montpellier Cedex 5, France
| | - Paramala Santosh
- Department of Child and Adolescent Psychiatry, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, 16 De Crespigny Park, London, SE5 8AF UK
| | - Giulia Signorini
- Psychiatric Epidemiology and Evaluation Unit, Saint John of God Clinical Research Center, Via Pilastroni 4, 25125 Brescia, Italy
| | | | - Helena Tuomainen
- Warwick Medical School, University of Warwick, Coventry, CV4 7AL UK
| | - Fiona McNicholas
- Lucena Clinic Rathgar , Dublin 6, Republic of Ireland
- University College Dublin, Belfield, Dublin 4, Republic of Ireland
- Our Lady’s Children Hospital Crumlin, Dublin 12, Republic of Ireland
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Ramsbottom H, Farmer LC. Reducing pediatric psychiatric hospital readmissions and improving quality care through an innovative Readmission Risk Predictor Tool. JOURNAL OF CHILD AND ADOLESCENT PSYCHIATRIC NURSING 2018; 31:14-22. [PMID: 29992678 DOI: 10.1111/jcap.12203] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2017] [Revised: 06/15/2018] [Accepted: 06/19/2018] [Indexed: 11/28/2022]
Abstract
PROBLEM Less than 30-day readmission has become a national problem. This pediatric medical center discovered that the primary diagnosis of Mood Disorder, not otherwise specified, was the third most common readmission diagnosis hospital-wide. Administration actively sought a resolution to less-than-30-day readmissions because All-Patient-Refined-Diagnostic-Related Groups would soon include pediatric hospitals with reimbursement impact. METHODS The Iowa Model for evidence-based practice framed the work of case management to identify readmission risk, reduce readmissions, and improve patient quality. In July 2014, the Readmit Predictor Tool (RPT) and Protocol were developed from literature review of contributing factors of pediatric psychiatric readmissions and assessed levels of readmission risk. The nurse case manager provided follow-up telephone calls to caregivers with children identified as moderate-to-high risk for readmissions. FINDINGS Effects of RPT use resulted in decreased readmissions by 29.5% in the first year, followed by 7.8% and 5.1% reductions in the second and third years, respectively, despite substantial increases in patient acuity during the period. CONCLUSION Using the RPT and initiating the psychiatry nurse case manager position, less-than-30-day readmissions decreased over a 3-year period.
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Affiliation(s)
- Helen Ramsbottom
- Department of Psychiatry, Cook Children's Medical Center, Fort Worth, Texas
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Roman SB, Matthews-Wilson A, Dickinson P, Chenard D, Rogers SC. Current Pediatric Emergency Department Innovative Programs to Improve the Care of Psychiatric Patients. Child Adolesc Psychiatr Clin N Am 2018; 27:441-454. [PMID: 29933793 DOI: 10.1016/j.chc.2018.02.004] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
Emergency departments (EDs) across North America have become a safety net for patients seeking mental health (MH) services. The prevalence of families seeking treatment of children in MH crisis has become a national emergency. To address MH access and improve quality and efficient management of children with MH conditions, the authors describe ED projects targeting this vulnerable population. Five North American health care systems volunteered to feature projects that seek to reduce ED visits and/or improve the care of MH patients: Allina Health, Nationwide Children's Hospital, Children's Hospital of Eastern Ontario, Connecticut Children's Medical Center, and Rhode Island Hospital.
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Affiliation(s)
- Susan B Roman
- Center for Care Coordination, Connecticut Children's Medical Center, 282 Washington Street, Hartford, CT 06106, USA.
| | - Allison Matthews-Wilson
- Center for Care Coordination, Connecticut Children's Medical Center, 282 Washington Street, Hartford, CT 06106, USA
| | - Patricia Dickinson
- Center for Care Coordination, Connecticut Children's Medical Center, 282 Washington Street, Hartford, CT 06106, USA
| | - Danielle Chenard
- Connecticut Children's Medical Center, 282 Washington Street, Hartford, CT 06106, USA
| | - Steven C Rogers
- University of Connecticut School of Medicine, 263 Farmington Avenue, Farmington, CT 06030, USA
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Tuomainen H, Schulze U, Warwick J, Paul M, Dieleman G, Franić T, Madan J, Maras A, McNicholas F, Purper-Ouakil D, Santosh P, Signorini G, Street C, Tremmery S, Verhulst F, Wolke D, Singh SP. Managing the link and strengthening transition from child to adult mental health Care in Europe (MILESTONE): background, rationale and methodology. BMC Psychiatry 2018; 18:167. [PMID: 29866202 PMCID: PMC5987458 DOI: 10.1186/s12888-018-1758-z] [Citation(s) in RCA: 31] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/21/2017] [Accepted: 05/22/2018] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND Transition from distinct Child and Adolescent Mental Health (CAMHS) to Adult Mental Health Services (AMHS) is beset with multitude of problems affecting continuity of care for young people with mental health needs. Transition-related discontinuity of care is a major health, socioeconomic and societal challenge globally. The overall aim of the Managing the Link and Strengthening Transition from Child to Adult Mental Health Care in Europe (MILESTONE) project (2014-19) is to improve transition from CAMHS to AMHS in diverse healthcare settings across Europe. MILESTONE focuses on current service provision in Europe, new transition-related measures, long term outcomes of young people leaving CAMHS, improving transitional care through 'managed transition', ethics of transitioning and the training of health care professionals. METHODS Data will be collected via systematic literature reviews, pan-European surveys, and focus groups with service providers, users and carers, and members of youth advocacy and mental health advocacy groups. A prospective cohort study will be conducted with a nested cluster randomised controlled trial in eight European Union (EU) countries (Belgium, Croatia, France, Germany, Ireland, Italy, Netherlands, UK) involving over 1000 CAMHS users, their carers, and clinicians. DISCUSSION Improving transitional care can facilitate not only recovery but also mental health promotion and mental illness prevention for young people. MILESTONE will provide evidence of the organisational structures and processes influencing transition at the service interface across differing healthcare models in Europe and longitudinal outcomes for young people leaving CAMHS, solutions for improving transitional care in a cost-effective manner, training modules for clinicians, and commissioning and policy guidelines for service providers and policy makers. TRIAL REGISTRATION "MILESTONE study" registration: ISRCTN ISRCTN83240263 Registered 23 July 2015; ClinicalTrials.gov NCT03013595 Registered 6 January 2017.
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Affiliation(s)
- H. Tuomainen
- Mental Health and Wellbeing, Division of Health Sciences, Warwick Medical School, University of Warwick, Coventry, UK
| | - U. Schulze
- Department of Child and Adolescent Psychiatry/Psychotherapy, University of Ulm, Ulm, Germany
| | - J. Warwick
- Warwick Clinical Trials Unit, Warwick Medical School, University of Warwick, Coventry, UK
| | - M. Paul
- Mental Health and Wellbeing, Division of Health Sciences, Warwick Medical School, University of Warwick, Coventry, UK
- Coventry and Warwickshire Partnership NHS Trust, Coventry, UK
| | - G.C. Dieleman
- Department of Child and Adolescent Psychiatry and Psychology, Erasmus Medical Center, Rotterdam, Netherlands
| | - T. Franić
- Department of Psychiatry, Clinical Hospital Center Split, Split, Croatia
| | - J. Madan
- Warwick Medical School, University of Warwick, Coventry, UK
| | - A. Maras
- Department of Child and Adolescent Psychiatry and Psychology, Erasmus Medical Center, Rotterdam, Netherlands
- Yulius Academy, Yulius Mental Health Organization, Barendrecht, Netherlands
| | - F. McNicholas
- Department of Child and Adolescent Psychiatry, University College Dublin School of Medicine and Medical Science, Dublin, Republic of Ireland
- Geary Institute, University College Dublin, Dublin, Republic of Ireland
- Department of Child Psychiatry, Our Lady’s Hospital for Sick Children, Dublin, Republic of Ireland
- Lucena Clinic SJOG, Dublin, Republic of Ireland
| | - D. Purper-Ouakil
- Centre Hospitalier Universitaire de Montpellier, Montpellier, France
| | - P. Santosh
- Department of Child and Adolescent Psychiatry, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, UK
- HealthTracker Ltd, Gillingham, UK
- Centre for Interventional Paediatric Psychopharmacology and Rare Diseases (CIPPRD), National and Specialist Child and Adolescent Mental Health Services, Maudsley Hospital, London, UK
| | - G. Signorini
- Psychiatric Epidemiology and Evaluation Unit, Saint John of God Clinical Research Center, Brescia, Italy
| | - C. Street
- Mental Health and Wellbeing, Division of Health Sciences, Warwick Medical School, University of Warwick, Coventry, UK
| | - S. Tremmery
- Department of Neurosciences, Child & Adolescent Psychiatry, University of Leuven, Leuven, Belgium
- Department of Child & Adolescent Psychiatry, University Hospitals Leuven, Leuven, Belgium
| | - F.C. Verhulst
- Department of Child and Adolescent Psychiatry and Psychology, Erasmus Medical Center, Rotterdam, Netherlands
| | - D. Wolke
- Mental Health and Wellbeing, Division of Health Sciences, Warwick Medical School, University of Warwick, Coventry, UK
- Department of Psychology, University of Warwick, Coventry, UK
| | - S. P. Singh
- Mental Health and Wellbeing, Division of Health Sciences, Warwick Medical School, University of Warwick, Coventry, UK
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Paul M, Ford T, Kramer T, Islam Z, Harley K, Singh SP. Transfers and transitions between child and adult mental health services. Br J Psychiatry 2018; 54:s36-40. [PMID: 23288500 DOI: 10.1192/bjp.bp.112.119198] [Citation(s) in RCA: 101] [Impact Index Per Article: 16.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
BackgroundTransfer of care from one healthcare provider to another is often understood as a suboptimal version of the process of transition.AimsTo separate and evaluate concepts of transfer and transition between child and adolescent mental health services (CAMHS) and adult mental health services (AMHS).MethodIn a retrospective case-note survey of young people reaching the upper age boundary at six English CAMHS, optimal transition was evaluated using four criteria: continuity of care, parallel care, a transition planning meeting and information transfer.ResultsOf 154 cases, 76 transferred to AMHS. Failure to transfer resulted mainly from non-referral by CAMHS (n = 12) and refusal by service users (n = 12) rather than refusal by AMHS (n = 7). Four cases met all criteria for optimal transition, 13 met none; continuity of care in(n = 63) was met most often.ConclusionsTransfer was common but good transition rare. Reasons for failure to transfer differ from barriers to transition. Transfer should be investigated alongside transition in research and service development.
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Eklund H, Findon J, Cadman T, Hayward H, Murphy D, Asherson P, Glaser K, Xenitidis K. Needs of Adolescents and Young Adults with Neurodevelopmental Disorders: Comparisons of Young People and Parent Perspectives. J Autism Dev Disord 2018; 48:83-91. [PMID: 28894999 PMCID: PMC5760588 DOI: 10.1007/s10803-017-3295-x] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/04/2022]
Abstract
This study used the Camberwell Assessment of Need for adults with Developmental and Intellectual Disabilities (CANDID) to examine the social, physical health and mental health needs of 168 young people (aged 14-24 years) with neurodevelopmental disorders and compared young person and parent ratings of need. Agreement was poor in 21 out of 25 domains. Parents consistently reported higher levels of need than young people in the majority of domains although young people with ADHD reported significantly more needs in physical health, eyesight/hearing, seizures, other mental health problems and safety of others than their parents. Both parent and young person perspectives of needs are necessary to ensure that needs that are predictive of current or future poor outcomes are not missed.
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Affiliation(s)
- Hanna Eklund
- Department of Forensic and Neurodevelopmental Science, Institute of Psychiatry, Psychology & Neuroscience, King's College London, De Crespigny Park, London, SE5 8AF, UK.
| | - James Findon
- Department of Forensic and Neurodevelopmental Science, Institute of Psychiatry, Psychology & Neuroscience, King's College London, De Crespigny Park, London, SE5 8AF, UK
| | - Tim Cadman
- Department of Forensic and Neurodevelopmental Science, Institute of Psychiatry, Psychology & Neuroscience, King's College London, De Crespigny Park, London, SE5 8AF, UK
| | - Hannah Hayward
- Department of Forensic and Neurodevelopmental Science, Institute of Psychiatry, Psychology & Neuroscience, King's College London, De Crespigny Park, London, SE5 8AF, UK
| | - Declan Murphy
- Department of Forensic and Neurodevelopmental Science, Institute of Psychiatry, Psychology & Neuroscience, King's College London, De Crespigny Park, London, SE5 8AF, UK
| | - Philip Asherson
- MRC Social Genetic and Developmental Psychiatry, Institute of Psychiatry, Psychology & Neuroscience, King's College London, De Crespigny Park, London, SE5 8AF, UK
| | - Karen Glaser
- Department of Social Sciences, Health and Medicine, Institute of Gerontology, King's College London, Strand, London, WC2R 2LS, UK
| | - Kiriakos Xenitidis
- Department of Forensic and Neurodevelopmental Science, Institute of Psychiatry, Psychology & Neuroscience, King's College London, De Crespigny Park, London, SE5 8AF, UK
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13
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Hobbs Knutson K, Meyer MJ, Thakrar N, Stein BD. Care Coordination for Youth With Mental Health Disorders in Primary Care. Clin Pediatr (Phila) 2018; 57:5-10. [PMID: 29090598 DOI: 10.1177/0009922817733740] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
Many children are treated for mental health disorders in primary care settings. The system of care (SOC) provides a framework for collaboration among pediatric mental health providers, but it is unclear if youth treated for mental health disorders in primary care receive such coordination. At the South Boston Community Health Center from September /2012 to August 2013 for 74 individuals ≤18 years, the odds of contact with SOC agencies (mental health, education, child protective services, juvenile justice and developmental disabilities) were compared for mental health treatment in primary versus specialty care. The odds of SOC contact within primary care were lower compared to specialty care (OR = 0.43, 95% CI = 0.29-0.66), specifically for mental health (OR = 0.54, 95% CI = 0.25-1.2), education (OR = 0.12, 95% CI = 0.050-0.28), and child protective services (OR = 0.64, 95% CI = 0.22-1.9). As care coordination may improve health outcomes, increased support and education for care coordination specific to youth treated for mental health disorders in primary care settings may be warranted.
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Affiliation(s)
| | | | - Nisha Thakrar
- 3 South Boston Community Health Center, Boston, MA, USA
| | - Bradley D Stein
- 4 RAND Corporation, Pittsburgh, PA, USA.,5 University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
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Clinical Update: Telepsychiatry With Children and Adolescents. J Am Acad Child Adolesc Psychiatry 2017; 56:875-893. [PMID: 28942810 DOI: 10.1016/j.jaac.2017.07.008] [Citation(s) in RCA: 68] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/30/2017] [Accepted: 07/17/2017] [Indexed: 01/17/2023]
Abstract
This Clinical Update reviews the use of telepsychiatry to deliver psychiatric, mental health, and care coordination services to children and adolescents across settings as direct service and in collaboration with primary care providers or other clinicians. The update defines terms and presents the current status of telepsychiatry as a mode of health service delivery. The update presents procedures for conducting telepsychiatry services and optimizing the clinical experience.
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15
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Myers K, Nelson EL, Rabinowitz T, Hilty D, Baker D, Barnwell SS, Boyce G, Bufka LF, Cain S, Chui L, Comer JS, Cradock C, Goldstein F, Johnston B, Krupinski E, Lo K, Luxton DD, McSwain SD, McWilliams J, North S, Ostrowski J, Pignatiello A, Roth D, Shore J, Turvey C, Varrell JR, Wright S, Bernard J. American Telemedicine Association Practice Guidelines for Telemental Health with Children and Adolescents. Telemed J E Health 2017; 23:779-804. [DOI: 10.1089/tmj.2017.0177] [Citation(s) in RCA: 65] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023] Open
Affiliation(s)
- Kathleen Myers
- Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, Seattle, Washington
- Department of Psychiatry and Behavioral Medicine, Seattle Children's Hospital, Seattle, Washington
| | - Eve-Lynn Nelson
- KU Center for Telemedicine & Telehealth, University of Kansas Medical Center, Kansas City, Kansas
- Department of Pediatrics, School of Medicine, University of Kansas Medical Center, Kansas City, Kansas
| | - Terry Rabinowitz
- Department of Psychiatry, Larner College of Medicine, University of Vermont, Burlington, Vermont
- Department of Family Medicine, Larner College of Medicine, University of Vermont, Burlington, Vermont
| | - Donald Hilty
- Psychiatry & Addiction Medicine, Kaweah Delta Medical Center, UC Irvine Affiliate, Visalia, California
- Department of Psychiatry, Keck School of Medicine at University of Southern California, Los Angeles, California
- Research and Health Services, Aligned Telehealth, Calabasas, California
| | - Deborah Baker
- Office of Legal and Regulatory Affairs, Practice Directorate, American Psychological Association, Washington, District of Columbia
| | - Sara Smucker Barnwell
- Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, Seattle, Washington
- Seattle Psychology PLLC, Seattle, Washington
| | | | - Lynn F. Bufka
- Practice Research and Policy, Practice Directorate, American Psychological Association, Washington, District of Columbia
| | - Sharon Cain
- Child and Adolescent Psychiatry Division, Department of Psychiatry and Behavioral Sciences, School of Medicine, University of Kansas Medical Center, Kansas City, Kansas
| | - Lisa Chui
- Department of Psychiatry and Behavioral Medicine, Seattle Children's Hospital, Seattle, Washington
| | - Jonathan S. Comer
- Center for Children and Families, Florida International University, Miami, Florida
- Mental Health Interventions and Technology (MINT) Program, Florida International University, Miami, Florida
| | | | | | | | - Elizabeth Krupinski
- Department of Radiology & Imaging Sciences, Emory University, Atlanta, Georgia
| | - Katherine Lo
- Department of Psychiatry and Behavioral Medicine, Seattle Children's Hospital, Seattle, Washington
| | - David D. Luxton
- Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, Seattle, Washington
- Office of Forensic Mental Health Services, State of Washington, Olympia, Washington
| | - S. David McSwain
- Department of Pediatrics, Medical University of South Carolina, Charleston, South Carolina
- Department of Telehealth Optimization, Medical University of South Carolina, Charleston, South Carolina
| | | | - Steve North
- Center for Rural Health Innovation, Spruce Pine, North Carolina
- Mission Virtual Care, Spruce Pine, North Carolina
| | - Jay Ostrowski
- Behavioral Health Innovation, Charlotte, North Carolina
| | - Antonio Pignatiello
- TeleLink Mental Health Program, The Hospital for Sick Children, Toronto, Ontario, Canada
- Medical Psychiatry Alliance, University of Toronto, Toronto, Ontario, Canada
- Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
| | - David Roth
- Mind and Body Works, Inc., Honolulu, Hawaii
| | - Jay Shore
- Department of Psychiatry, Center for American Indian and Alaska Native Health, University of Colorado, Denver, Colorado
- Telepsychiatry Committee, American Psychiatric Association, Arlington, Virginia
| | - Carolyn Turvey
- Department of Psychiatry, Carver School of Medicine, University of Iowa, Iowa City, Iowa
| | | | - Shawna Wright
- KU Center for Telemedicine & Telehealth, University of Kansas Medical Center, Kansas City, Kansas
- Wright Psychological Services, Chanute, Kansas
| | - Jordana Bernard
- American Telemedicine Association, Washington, District of Columbia
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16
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Boris NW, Renk K. Beyond Reactive Attachment Disorder: How Might Attachment Research Inform Child Psychiatry Practice? Child Adolesc Psychiatr Clin N Am 2017; 26:455-476. [PMID: 28577603 DOI: 10.1016/j.chc.2017.03.003] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
This article provides an updated review of attachment research with a focus on how comprehensive clinical assessment and intervention informs the care of young children. Child psychiatrists can serve as an important part of care coordination teams working with young children who have histories of early maltreatment and/or disruption in caregiving whether or not the children they are seeing meet criteria for an attachment disorder. Child psychiatrists should be familiar with both comprehensive assessment and the recent attachment-based interventions and appreciate how pharmacotherapy can be a useful adjunctive intervention when intensive therapy alone is ineffective.
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Affiliation(s)
- Neil W Boris
- Center for Prevention and Early Intervention Policy, Florida State University, 1339 East Lafayette Street, Tallahassee, FL 32301, USA.
| | - Kimberly Renk
- Department of Psychology, University of Central Florida, 4111 Pictor Lane, Psychology Building (99), Room 353, Orlando, FL 32816, USA
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17
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Olashore AA, Rukewe A. Polypharmacy among children and adolescents with psychiatric disorders in a mental referral hospital in Botswana. BMC Psychiatry 2017; 17:174. [PMID: 28486963 PMCID: PMC5424412 DOI: 10.1186/s12888-017-1347-6] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/15/2016] [Accepted: 05/03/2017] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND There is a dearth of data on polypharmacy in child and adolescent mental health in Africa, especially Botswana where children and adults are treated in the same facility by general adult psychiatrists. This study was therefore designed to assess the prevalence and the risk factors of psychiatric polypharmacy among children and adolescents treated at Sbrana Psychiatric Hospital, Lobatse, Botswana. METHODS Data involving socio-demographics, diagnosis (using ICD-10 classification) and pharmacological treatment were retrieved from the records of 120 children and adolescents aged below 18 years, between 1 January 2012 and 31 July 2016, who presented with psychiatric disorders. They were analysed with univariate and multivariate models. RESULTS The prevalence of psychiatric polypharmacy was 29.2%. Psychiatric co-morbidity (OR = 3.374, 95% CI: 1.177-9.9673) and psychotropic side effects (OR = 5.782, 95% CI: 1.636-20.430) were significantly associated with polypharmacy after regression analysis. CONCLUSION Psychiatric co-morbidity and psychotropic side effects were significant risk factors for polypharmacy in Botswana.
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Affiliation(s)
- Anthony A. Olashore
- 0000 0004 0635 5486grid.7621.2Department of Psychiatry, University of Botswana, Gaborone, Botswana
| | - Ambrose Rukewe
- 0000 0004 0635 5486grid.7621.2Department of Anesthesia and Critical Care, University of Botswana, Gaborone, Botswana
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18
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Abstract
The emotional health and wellbeing of children and adolescents and their families is of utmost importance. Pediatricians are at the front line in identifying mental illness in children and adolescents and either linking them to resources in the community or providing treatment options themselves. Collaboration and integrative health care models is the cornerstone of effective strategies to provide access and quality mental health care to children and families in communities across the country.
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19
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Paul M, Street C, Wheeler N, Singh SP. Transition to adult services for young people with mental health needs: A systematic review. Clin Child Psychol Psychiatry 2015; 20:436-57. [PMID: 24711585 DOI: 10.1177/1359104514526603] [Citation(s) in RCA: 89] [Impact Index Per Article: 9.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Young people's transition from child and adolescent (CAMHS) to adult mental health services (AMHS). OBJECTIVES To systematically review evidence on the effectiveness of different models of CAMHS-AMHS transitional care, service user and staff perspectives, and facilitators of/barriers to effective CAMHS-AMHS transition. DATA SOURCES A systematic search in May 2012 of Medline, PsycINFO, CINAHL, EMBASE, AMED, Health Business Elite, HMIC, Cochrane Database, Web of Science and ASSIA; ancestral searches; and consultation with experts in the field. STUDY SELECTION Qualitative, quantitative and mixed-methods primary research on the CAMHS-AMHS health-care transition of young people (aged 16-21 years) with mental health problems. DATA EXTRACTION Two reviewers independently completed a standardised data extraction form and critically evaluated identified documents using a validated appraisal tool for empirical studies with varied methodologies. RESULTS A total of 19 studies of variable quality were identified. None were randomised or case-controlled trials. Studies incorporating service user/carer perspectives highlighted the need to tackle stigma and provide accessible, age-appropriate services. Parents/carers wanted more involvement with AMHS. Transitional care provision was considered patchy and often not prioritised within mental health services. There was no clear evidence of superior effectiveness of any particular model. CONCLUSIONS High-quality evidence of transitional care models is lacking. Data broadly support the development of programmes that address the broader transitional care needs of 'emerging adults' and their mental health needs but further evaluation is necessary. Developing robust transitional mental health care will require the policy-practice gap to be addressed and development of accessible, acceptable, responsive, age-appropriate provision.
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Affiliation(s)
- Moli Paul
- Division of Mental Health and Wellbeing, Warwick Medical School, The University of Warwick, UK
| | - Cathy Street
- Research and Innovation Department, Birmingham and Solihull Mental Health NHS Foundation Trust, UK
| | - Nicola Wheeler
- Research and Innovation Department, Birmingham and Solihull Mental Health NHS Foundation Trust, UK
| | - Swaran P Singh
- Division of Mental Health and Wellbeing, Warwick Medical School, The University of Warwick, UK
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20
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Wald HP, Zubritsky CD, Jaquette N. Measuring system of care core values in a behavioral health system of care. Community Ment Health J 2014; 50:275-80. [PMID: 23959608 DOI: 10.1007/s10597-013-9639-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/20/2012] [Accepted: 07/29/2013] [Indexed: 11/28/2022]
Abstract
The Comprehensive Services for Children and Their Families or System of Care (SOC) is the largest mental health project ever conducted by the US federal government. These programs are based on a value-driven framework that includes: child/youth centered and family driven practice, community-based practice, and culturally competent practice (Stroul and Friedman in A system of care for children and youth with severe emotional disturbances, Georgetown University Child Development Center, CASSP Technical Assistance Center, Washington, DC, 1986). The aim of this study is to determine the extent of the adoption of SOC values by families, system partners, providers and community organizations in a countywide SOC. Using a retrospective design, data was collected through a system-wide survey and focus groups, which asked respondents to rate the presence of SOC core values prior to and four years following its creation. Results suggest that system partners, provider staff, and families are aware of the changes that have occurred within the system as a result of the SOC.
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21
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Jung KH, Ahn DH, Kim JY, Kim HJ, Bang YW. A Practice Patterns of Child and Adolescent Psychiatrists in South Korea. Soa Chongsonyon Chongsin Uihak 2014. [DOI: 10.5765/jkacap.2014.25.1.6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
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22
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Pumariega AJ, Rothe E, Mian A, Carlisle L, Toppelberg C, Harris T, Gogineni RR, Webb S, Smith J. Practice parameter for cultural competence in child and adolescent psychiatric practice. J Am Acad Child Adolesc Psychiatry 2013; 52:1101-15. [PMID: 24074479 DOI: 10.1016/j.jaac.2013.06.019] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/04/2013] [Accepted: 06/26/2013] [Indexed: 10/26/2022]
Abstract
The United States faces a rapidly changing demographic and cultural landscape, with its population becoming increasingly multiracial and multicultural. In consequence, cultural and racial factors relating to mental illness and emotional disturbances deserve closer attention and consideration. This Practice Parameter outlines clinical applications of the principle of cultural competence that will enable child and adolescent mental health clinicians to better serve diverse children, adolescents, and their families.
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23
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Ronzoni P, Dogra N. Children, adolescents and their carers' expectations of child and adolescent mental health services (CAMHS). Int J Soc Psychiatry 2012; 58:328-36. [PMID: 21242172 DOI: 10.1177/0020764010397093] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND The use of service users' views as performance indicators highlights the trend to make services more responsive to patients' needs. However, recent research indicates that there is a lack of clear understanding about specialist CAMHS and the outcomes that children, adolescents and their parents hope to achieve from treatment differ. AIMS To explore children/young people's and parents/carers' expectations of CAMHS in Leicestershire, England. METHODS Sixty children/young people and their parents/carers were asked to identify goals they want to achieve following contact with CAMHS. Qualitative thematic analysis in relation to Hoagwood's SFCES model (Symptoms, Functional, Consumer perspectives, Environment and Systems) was used. RESULTS The question was answered by 46.7% of children and young people and 60% of carers. Overall, children, young people and parents/carers agreed that symptomatic modification and functional aspects were the most important goals. However, internalising items seemed more important for parents/carers than children and adolescents, who in contrast hoped for improvement in externalising factors. Goals outside the scope of CAMHS were also noted for both groups. CONCLUSION Attention to children/young people and their parents/carers' expectations of services is needed to improve therapeutic relationships and engagement. Improvement in mental health literacy and practitioners' guidance is required to allow service users to set realistic and achievable treatment goals.
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Affiliation(s)
- Pablo Ronzoni
- Greenwood Institute of Child Health, University of Leicester, UK.
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24
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Newman L, Birleson P. Mental health planning for children and youth: is it developmentally appropriate? Australas Psychiatry 2012; 20:91-7. [PMID: 22467561 DOI: 10.1177/1039856211432479] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
OBJECTIVES We aim to provide an overview of current issues facing child and adolescent mental health services and the provision of developmentally informed and appropriate care. METHOD We review developmental models of mental disorder and the impact on service design. RESULTS Developmental issues can shape service design. CONCLUSIONS Mental health services need to be informed and responsive to changing developmental needs and of the context of child development in terms of family and attachment relationships. Children and adolescents have specific needs in terms of service design.
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Affiliation(s)
- Louise Newman
- Centre for Developmental Psychiatry and Psychology, Monash University, Clayton, VIC Australia
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25
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Dell ML. Child and adolescent depression: psychotherapeutic, ethical, and related nonpharmacologic considerations for general psychiatrists and others who prescribe. Psychiatr Clin North Am 2012; 35:181-201. [PMID: 22370498 DOI: 10.1016/j.psc.2011.12.002] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
Depression is a common, recurring disorder affecting millions of youth at some point before they reach mature adulthood. Given the shortage of and uneven distribution of psychiatrists who have completed specialized fellowships in child and adolescent psychiatry, a significant number of depressed youth will receive their pharmacotherapy from general psychiatrists and other prescribers with varying degrees of interest, training, and even willingness to treat children and adolescents. For general psychiatrists who will prescribe antidepressants for minors, knowledge of the training and expertise of nonphysician mental health professionals, the psychotherapies they may employ, and familiarity with school services are essential. Physicians who typically work only with adults will also need familiarity with differing ethical, legal, and regulatory issues and standards applicable to pediatric psychopharmacology. General psychiatrists, pediatricians, family physicians, nurse practitioners, and others contribute greatly to the care of depressed children, adolescents, and their families, and many find this work to be a very rewarding part of their professional practices.
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Affiliation(s)
- Mary Lynn Dell
- Case Western Reserve University School of Medicine, 10524 Euclid Avenue, W.O. Walker Building, Suite 1155A, Cleveland, OH 44106, USA.
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26
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Lunn LM, Heflinger CA, Wang W, Greenbaum PE, Kutash K, Boothroyd RA, Friedman RM. Community characteristics and implementation factors associated with effective systems of care. J Behav Health Serv Res 2011; 38:327-41. [PMID: 21594747 DOI: 10.1007/s11414-011-9244-0] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
How are characteristics of communities associated with the implementation of the principles of systems of care (SOC)? This study uses multilevel modeling with a stratified random sample (N = 225) of US counties to explore community-level predictors of the implementation factors of the System of Care Implementation Survey. A model composed of community-level social indicators fits well with 5 of 14 factors identified as relevant for effective SOCs. As hypothesized, community disadvantage was negatively and residential stability positively associated with the implementation of SOC principles. Designation as a mental health professional shortage area was positively related to some implementation scores, as was the percentage of minority residents, while rurality was not significantly associated with any of the factors. Given the limitations of the study, the results should be interpreted with caution, but suggest that further research is merited to clarify these relationships that could inform efforts directed at promoting SOCs.
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Affiliation(s)
- Laurel M Lunn
- Department of Human and Organizational Development, Peabody College, Vanderbilt University, 230 Appleton Place, Box #90 Peabody, Nashville, TN 37203, USA.
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27
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Grady B, Myers KM, Nelson EL, Belz N, Bennett L, Carnahan L, Decker VB, Holden D, Perry G, Rosenthal L, Rowe N, Spaulding R, Turvey CL, White R, Voyles D. Evidence-based practice for telemental health. Telemed J E Health 2011; 17:131-48. [PMID: 21385026 DOI: 10.1089/tmj.2010.0158] [Citation(s) in RCA: 100] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Affiliation(s)
- Brian Grady
- University of Maryland-Psychiatry , Baltimore, Maryland, USA
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28
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Chenven M. Community Systems of Care for Children's Mental Health. Child Adolesc Psychiatr Clin N Am 2010; 19:163-74; table of contents. [PMID: 19951815 DOI: 10.1016/j.chc.2009.08.006] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Although the future of the systems of care model continues to evolve, the core values of child psychiatry are well supported and well served in this emerging arena of public children's mental health service delivery. A substantial body of evidence supports the concepts and practices of family-driven care congruent with wraparound principles and practices. Individual and system outcomes data show efficacy for programs that integrate traditional professional services with consumer-centric wraparound approaches, such as mentoring, team decision making, and community-based services and supports. Integrative interagency practice, fostering cross-agency collaboration to address the needs of at-risk populations, has been shown to be central in providing supports for families and youth.
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Affiliation(s)
- Mark Chenven
- Division of Child and Adolescent Psychiatry, Department of Psychiatry, UCSD Medical School, San Diego, CA 92123, USA.
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29
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Leathers SJ, McMeel LS, Prabhughate A, Atkins MS. Trends in Child Welfare's Focus on Children's Mental Health and Services from 1980-2004. CHILDREN AND YOUTH SERVICES REVIEW 2009; 31:445-450. [PMID: 20161261 PMCID: PMC2699688 DOI: 10.1016/j.childyouth.2008.09.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
This study examined how one of the oldest and most widely distributed child welfare practice journals addressed children's mental health issues over a 25-year period. The content of 478 articles was coded. Logistic regression findings indicate that mental health issues were discussed less frequently over the first half of the period examined, and then more frequently over the last decade. Residential treatment was discussed less frequently over time, but other community-based alternatives to residential treatment were rarely discussed at any point, so that overall the content related to treatment of mental health issues decreased as discussion of residential treatment decreased. These findings suggest that although the child welfare literature has recently focused more on children's mental health, dissemination of specific concepts from the mental health to the child welfare literature does not naturally occur over time. Efforts targeted at dissemination of effective community-based mental health interventions for foster children may be needed to support this process.
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30
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Doig JL, McLennan JD, Urichuk L. 'Jumping through hoops': parents' experiences with seeking respite care for children with special needs. Child Care Health Dev 2009; 35:234-42. [PMID: 19228157 DOI: 10.1111/j.1365-2214.2008.00922.x] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
BACKGROUND Respite care may act as a means to reduce stress and fatigue in people caring for a dependent who has a disability. Despite this, a variety of barriers may exist to obtaining such services. This study explored caregivers' experiences seeking respite care for their children with special needs within a province in Canada. METHODS Caregivers were recruited from two agencies providing respite care for children with fetal alcohol spectrum disorders and other mental health and developmental difficulties. In total, 10 caregivers participated in in-depth individual interviews. A constructivist grounded theory approach was employed in the design and analysis of the data. RESULTS Caregivers discussed their frustrations with the process of finding and obtaining respite care, a course of action described as 'jumping through hoops'. This construct was composed of subcategories emphasizing the complexity of 'navigating the system', the bidirectional process of 'meeting the requirements' and the challenges of 'getting help'. CONCLUSIONS The collective experiences of these caregivers point to the need for more flexibility and co-ordination of respite care services for children with special needs.
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Affiliation(s)
- J L Doig
- Department of Health Sciences, University of Calgary, AB, CAnada
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31
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Abstract
Child and adolescent psychiatrists and general psychiatrists who serve children and adolescents with complex mental health needs, generally find themselves interfacing with multiple child-serving systems, including mental health, child welfare, juvenile justice, developmental disabilities, addictions services, and primary health care. In these systems of care, psychiatrists will likely encounter the term "wraparound," which describes a key intervention ushered in with the system-of-care model of service delivery. This article describes the wraparound approach, which has been at the forefront of mental health service delivery for children and youth with serious emotional disturbance since the mid-1980s. Wraparound is an empirically supported, family-driven, strengths-based planning approach that provides individualized care using an array of formal services and natural supports.
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Affiliation(s)
- Nancy C Winters
- Department of Psychiatry, Oregon Health & Science University, Portland, OR 97239-3098, USA.
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32
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Milam-Miller S. The psychiatrist as consultant: working within schools, the courts, and primary care to promote children's mental health. Psychiatr Clin North Am 2009; 32:165-76. [PMID: 19248923 DOI: 10.1016/j.psc.2008.10.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
This article presents a broad description of psychiatric consultation to schools to introduce concepts relevant in all child and adolescent psychiatric consultation outside of the hospital setting. A model of the consultation process is presented, which includes: (1) the consultant's entry into the system that is requesting consultation, (2) the process of defining the question posed, (3) identification of the focus of consultation and the consultant's role, and (4) measuring outcomes. Cases from psychiatric consultation to schools, juvenile justice, and primary care illustrate the various roles that a consultant may fill in providing consultative services for children and adolescents. Current trends in psychiatric consultation are described, including a shift away from indirect consultation and toward a collaborative role.
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Abstract
This practice parameter discusses the use of telepsychiatry to provide services to children and adolescents. The parameter defines terms and reviews the status of telepsychiatry as a mode of health service delivery. Because many of the issues addressed are unique to telepsychiatry, the parameter presents principles for establishing a telepsychiatry service and optimizing clinical practice within that service. The principles presented are based on existing scientific evidence and clinical consensus. Telepsychiatry is still evolving, and this parameter represents a first approach to determining "best practices." The parameter emphasizes the integration of telepsychiatry within other practice parameters of the American Academy of Child and Adolescent Psychiatry.
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Davis E, Barnhill LJ, Saeed SA. Treatment models for treating patients with combined mental illness and developmental disability. Psychiatr Q 2008; 79:205-23. [PMID: 18726155 DOI: 10.1007/s11126-008-9082-2] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/20/2008] [Accepted: 08/04/2008] [Indexed: 11/26/2022]
Abstract
The presence of co-occurring psychiatric disorders among individuals with developmental disability (DD) requires clinicians to adjust and modify standard mental health assessment and treatment planning. In particular, assessment includes input from a multi-disciplinary team and as a result, diagnosis is frequently a synthesis of data from many different points of view. Treatment planning and implementation commonly include a collection of highly specialized, individualized programs that focus on the long term management of both disorders. Crises and recurrence of mental disorders are commonplace in part due to the presence of ongoing risk and vulnerability factors for mental disorders. As a result, the need for emergency interventions, specialized respite services, hospitalization and other transition services is extensive. The quality, availability and access to these services vary considerably. Many programs are concentrated in metropolitan or university-based centers and pose hardships based on geographic distance. The availability and utilization of services is affected by political, economic, socio-cultural and psychological forces that impact both the willingness to use services and the distribution of professionals trained and qualified to manage individuals with dual diagnoses. The complex interaction between each of these factors determines the structure, function, and capacity for innovation built into current service models.
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Affiliation(s)
- Ervin Davis
- Department of Psychology, East Carolina University, Greenville, NC 27858, USA.
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Pignatiello A, Boydell K, Teshima J, Volpe T. Supporting Primary Care Through Pediatric Telepsychiatry. ACTA ACUST UNITED AC 2008. [DOI: 10.7870/cjcmh-2008-0024] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
This paper describes a pediatric telepsychiatry program serving communities in rural Ontario, Canada. Since the program's inception in 2000, over 4,300 direct clinical consultations have been provided for a variety of presenting issues. Indirect consultations and educational sessions have augmented clinicians' knowledge. Participant evaluation of the program indicates that a comprehensive model of psychiatric consultation and education can be delivered effectively via live interactive videoconferencing to support primary care and to enhance capacity in remote, underserviced areas in Ontario.
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Affiliation(s)
- Antonio Pignatiello
- Telepsychiatry Program, Hospital for Sick Children and Division of Child Psychiatry, and Department of Psychiatry, University of Toronto, Ontario
| | - Katherine Boydell
- Community Health Systems Resource Group, Child Health Evaluative Sciences Research Institute, Hospital for Sick Children, and Department of Psychiatry and Dalla Lama School of Public Health, University of Toronto, Ontario
| | - John Teshima
- Department of Psychiatry, University of Toronto, and Sunnybrook Health Sciences Centre, Toronto, Ontario
| | - Tiziana Volpe
- Community Health Systems Resource Group, Hospital for Sick Children, and Institute of Medical Science, University of Toronto, Ontario
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