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Swart TT, Davids EL, de Vries PJ. "A turn in the road, but still a rough journey" - Parent and child perspectives of outcomes after pre-adolescent inpatient psychiatric admission. Child Adolesc Psychiatry Ment Health 2023; 17:103. [PMID: 37660076 PMCID: PMC10475176 DOI: 10.1186/s13034-023-00649-0] [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: 03/26/2023] [Accepted: 08/20/2023] [Indexed: 09/04/2023] Open
Abstract
BACKGROUND Research regarding the outcomes of child and adolescent psychiatric inpatients appears insufficient and neglected. Where data are available, the majority of studies focus on adolescents. This study aimed (a) to describe child and parental perspectives of short-, medium- and long-term outcomes of children who have had a pre-adolescent inpatient psychiatric admission, and (b) to analyse these dyadic experiential data to identify outcome variables of importance to families and service users that could be used in future outcomes-based research. METHODS The study employed a qualitative methodology, using semi-structured in-depth interviews of ten parent-child dyads to (a) collect the perspectives of children who have had an inpatient psychiatric admission at a pre-adolescent unit and their parents, and (b) to analyse the experiences of inpatient admission and perceived outcomes after discharge using thematic analysis. RESULTS Overall, inpatient psychiatric admission was viewed as a positive and empowering experience by parents and children. Clear short-term benefits were reported as a result of new diagnoses, medications and new skills gained through the admission process. More than half of parent-child dyads reported long-term benefits, but many families commented on ongoing challenges. Thematic analysis identified diagnostic certainty, acquisition of cognitive and behavioural skills, appropriate educational environment, peer relationships, sustained follow-up and medication management, and parent-child relationships, as important contributors to outcomes. Importantly, the presence or lack of these elements influenced outcomes. CONCLUSIONS The study explored parent-child dyadic perspectives about their experiences of inpatient mental health admissions for pre-adolescents and perceived outcomes after admission. The majority of families found inpatient admission positive and helpful, and thematic analysis identified a number of functional variables that may predict outcome. However, positive outcomes were associated with ongoing difficulties over time, as indicated by the theme "a turn in the road, but still a rough journey".
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Affiliation(s)
- Tania T Swart
- Division of Child & Adolescent Psychiatry, University of Cape Town, Cape Town, South Africa
| | - Eugene L Davids
- Division of Child & Adolescent Psychiatry, University of Cape Town, Cape Town, South Africa.
| | - Petrus J de Vries
- Division of Child & Adolescent Psychiatry, University of Cape Town, Cape Town, South Africa
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Kaku SM, Sibeoni J, Basheer S, Chang JPC, Dahanayake DMA, Irarrazaval M, Lachman JM, Mapayi BM, Mejia A, Orri M, Jui-Goh T, Uddin MS, Vallance I. Global child and adolescent mental health perspectives: bringing change locally, while thinking globally. Child Adolesc Psychiatry Ment Health 2022; 16:82. [PMID: 36345001 PMCID: PMC9640779 DOI: 10.1186/s13034-022-00512-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/31/2022] [Accepted: 08/03/2022] [Indexed: 11/09/2022] Open
Abstract
Child and adolescent mental health (CAMH) are a global priority. Different countries across the globe face unique challenges in CAMH services that are specific to them. However, there are multiple issues that are also similar across countries. These issues have been presented in this commentary from the lens of early career CAMH professionals who are alumni of the Donald J Cohen Fellowship program of the IACAPAP. We also present recommendations that can be implemented locally, namely, how promoting mental health and development of children and adolescents can result in better awareness and interventions, the need to improve quality of care and access to care, use of technology to advance research and practices in CAMH, and how investing in research can secure and support CAMH professionals and benefit children and adolescents across the globe. As we continue to navigate significant uncertainty due to dynamic circumstances globally, bolstering collaborations by "bringing change locally, while thinking globally" are invaluable to advancing global CAMH research, clinical service provision, and advancement of the field.
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Affiliation(s)
- Sowmyashree Mayur Kaku
- Centre for Advanced Research and Excellence in Autism and Developmental Disorders (CAREADD), St. John's Medical College Hospital and St. John's Research Institute, Bangalore, India.
| | - Jordan Sibeoni
- Service Universitaire de Psychiatrie de l’Adolescent, Argenteuil Hopital Centre, Cedex, France ,grid.508487.60000 0004 7885 7602ECSTRRA Team, UMR-1153, Université de Paris, Inserm, Paris, France
| | - Salah Basheer
- grid.513003.4Department of Psychiatry, Iqraa International Hospital and Research Centre, Kozhikode, Kerala India
| | - Jane Pei-Chen Chang
- grid.411508.90000 0004 0572 9415Child Psychiatry Division, Department of Psychiatry, College of Medicine, China Medical University Hospital, Taichung, Taiwan
| | | | - Matias Irarrazaval
- Millenium Institute for Research in Depression and Personality, Santiago, Chile
| | - Jamie M Lachman
- grid.4991.50000 0004 1936 8948Department of Social Policy and Intervention, University of Oxford, Oxford, UK
| | - Boladale Moyosore Mapayi
- grid.10824.3f0000 0001 2183 9444Mental health, Obafemi Awolowo University, Ile Ife, Osun State Nigeria
| | - Anilena Mejia
- grid.5379.80000000121662407Division of Psychology of Mental Health, The University of Manchester, Manchester, UK
| | - Massimiliano Orri
- grid.412078.80000 0001 2353 5268Department of Psychiatry, McGill Group for Suicide Studies, Douglas Mental Health University Institute, McGill University, Montreal, QC Canada
| | - Tze Jui-Goh
- grid.414752.10000 0004 0469 9592Department of Developmental Psychiatry, Institute of Mental Health, Buangkok Green, Singapore
| | - Md Saleh Uddin
- grid.440425.30000 0004 1798 0746Jeffrey Cheah School of Medicine and Health Sciences, Monash University (Malaysia campus), Bandar Sunway, Malaysia
| | - Inge Vallance
- grid.4991.50000 0004 1936 8948Department of Social Policy and Intervention, University of Oxford, Oxford, UK
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Rossi R, Ridolfi ME. Borderline personality disorder in young people: state of the art and future plans in Italy. Curr Opin Psychol 2020; 37:61-65. [PMID: 32877857 DOI: 10.1016/j.copsyc.2020.08.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2020] [Revised: 08/10/2020] [Accepted: 08/11/2020] [Indexed: 11/30/2022]
Abstract
Treatment of Borderline Personality Disorder (BPD) in Italy has a relatively recent history. In the last few years, based on the increasing number of BPD patients admitted in Italian Mental Health Services (MHS), several regions have introduced treatment for BPD among their clinical priorities. A general 'call for action' has been launched within the psychiatric community. The aim of the current review is to describe the state of the art of research and clinical programs for personality disorders in young people. The Italian clinical context will be described with a focus on the transition discontinuity of care between adult and child/adolescent services. Prevention and early intervention programs available in Italy will be reviewed and a new agenda will be discussed.
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Affiliation(s)
- Roberta Rossi
- Unit of Psychiatry, IRCCS Istituto Centro San Giovanni di Dio - FBF, Brescia, Italy.
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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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The interface between child/adolescent and adult mental health services: results from a European 28-country survey. Eur Child Adolesc Psychiatry 2018; 27:501-511. [PMID: 29368253 DOI: 10.1007/s00787-018-1112-5] [Citation(s) in RCA: 58] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/18/2017] [Accepted: 01/13/2018] [Indexed: 12/14/2022]
Abstract
Transition-related discontinuity of care is a major socioeconomic and societal challenge for the EU. The current service configuration, with distinct Child and Adolescent Mental Health (CAMHS) and Adult Mental Health Services (AMHS), is considered a weak link where the care pathway needs to be most robust. Our aim was to delineate transitional policies and care across Europe and to highlight current gaps in care provision at the service interface. An online mapping survey was conducted across all 28 European Countries using a bespoke instrument: The Standardized Assessment Tool for Mental Health Transition (SATMEHT). The survey was directed at expert(s) in each of the 28 EU countries. The response rate was 100%. Country experts commonly (12/28) reported that between 25 and 49% of CAMHS service users will need transitioning to AMHS. Estimates of the percentage of AMHS users aged under 30 years who had has previous contact with CAMHS were most commonly in the region 20-30% (33% on average).Written policies for managing the interface were available in only four countries and half (14/28) indicated that no transition support services were available. This is the first survey of CAMHS transitional policies and care carried out at a European level. Policymaking on transitional care clearly needs special attention and further elaboration. The Milestone Study on transition should provide much needed data on transition processes and outcomes that could form the basis for improving policy and practice in transitional care.
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Piazza A, Rucci P, Clo M, Gibertoni D, Camellini L, Di Stani M, Fantini MP, Ferri M, Fioritti A. Health services utilization in patients with eating disorders: evidence from a cohort study in Emilia-Romagna. Eat Weight Disord 2016; 21:625-633. [PMID: 27682243 DOI: 10.1007/s40519-016-0323-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/18/2016] [Accepted: 09/12/2016] [Indexed: 10/20/2022] Open
Abstract
PURPOSE To estimate the treated prevalence of eating disorders (ED) in Emilia-Romagna, Italy, and to compare health services utilization among age groups and geographical areas. METHODS The study cohort consists of patients aged 12-64 years with a primary or secondary ED diagnosis, treated in regional healthcare facilities in 2012. Patients were followed up for 1 year from the first contact. Data were extracted from regional administrative databases. RESULTS The study cohort included 1550 cases, 36.8 % with anorexia nervosa, 21.9 % with bulimia nervosa and 41.3 % with ED not otherwise specified. Adolescents (12-17 years) were 18.6 %, young adults (18-30) 32.7 % and older adults (31-64) 48.7 %. The annual treated prevalence rate was 5.2/10,000 (13.3 for adolescents, 9.3 for young adults and 3.4 for older adults) and was highest among adolescent (24.6/10,000) and young adult females (17.1/10,000). Cases without a record for ED in the previous year were 46.8 %. Older adults displayed higher comorbidity and used more services including hospital-based care. Outpatient care greatly exceeded inpatient care across age groups. Variations in care patterns across regional areas were found. CONCLUSIONS Our results indicate that the care pathway for ED varies among age groups and geographical areas, but is consistent with the regional care model that favors the use of outpatient services. Future perspectives include evaluating the integration among mental health services, specialty outpatient units and primary care.
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Affiliation(s)
- Antonella Piazza
- Department of Mental Health and Pathological Addictions, Bologna Local Health Authority, Bologna, Italy
| | - Paola Rucci
- Department of Biomedical and Neuromotor Sciences, Alma Mater Studiorum-University of Bologna, Via San Giacomo, 12, 40126, Bologna, Italy.
| | - Massimo Clo
- Information System Unit, Health Care and Social Authority, Emilia-Romagna Region, Bologna, Italy
| | - Dino Gibertoni
- Department of Biomedical and Neuromotor Sciences, Alma Mater Studiorum-University of Bologna, Via San Giacomo, 12, 40126, Bologna, Italy
| | - Lucia Camellini
- Innovation and Organizational Evaluation Service, Modena Local Health Authority, Modena, Italy
| | - Marinella Di Stani
- Department of Mental Health and Pathological Addictions, Romagna Local Health Authority, Ravenna, Italy
| | - Maria Pia Fantini
- Department of Biomedical and Neuromotor Sciences, Alma Mater Studiorum-University of Bologna, Via San Giacomo, 12, 40126, Bologna, Italy
| | - Mila Ferri
- Outpatient Care Unit, Health Care and Social Authority, Emilia-Romagna Region, Bologna, Italy
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Hazell P, Sprague T, Sharpe J. Psychiatric hospital treatment of children and adolescents in New South Wales, Australia: 12-year trends. BJPsych Open 2016; 2:1-5. [PMID: 27703746 PMCID: PMC4998942 DOI: 10.1192/bjpo.bp.115.000794] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/23/2015] [Revised: 10/08/2015] [Accepted: 11/25/2015] [Indexed: 12/03/2022] Open
Abstract
BACKGROUND It is preferable that children and adolescents requiring in-patient care for mental health problems are managed in age-appropriate facilities. To achieve this, nine specialist Child and Adolescent Mental Health Services (CAMHS) in-patient units have been commissioned in New South Wales (NSW) since 2002. AIMS To examine trends in child and adolescent in-patient admissions since the opening of these CAMHS units. METHOD Analysis of separation data for under 18-year-olds to CAMHS, adult mental health and paediatric units for the period 2002 to 2013 in NSW, comparing districts with and without specialist CAMHS units. RESULTS Separations from CAMHS, adult and paediatric units rose with time, but there was no interaction between time and health district type (with/without CAMHS unit). Five of eight health districts experienced increased separations of under 18-year-olds from adult units in the year of opening a CAMHS unit. Separations from related paediatric units increased in three of seven health districts. CONCLUSIONS Opening CAMHS units may be followed by a temporary increase in separations of young people from adult units, but it does not influence the flow of patients to non-CAMHS facilities in the longer term. DECLARATION OF INTEREST None. COPYRIGHT AND USAGE © The Royal College of Psychiatrists 2016. This is an open access article distributed under the terms of the Creative Commons Non-Commercial, No Derivatives (CC BY-NC-ND) licence.
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Affiliation(s)
- Philip Hazell
- Philip Hazell, BMedSc, MBChB, PhD, FRANZCP, Cert Accred Child Psychiatry (RANZCP), Conjoint Professor of Child and Adolescent Psychiatry, The University of Sydney, Sydney, NSW, Australia
| | - Titia Sprague
- Titia Sprague, MBBS, MPH, MBA, FRANZCP, Cert Accred Child Psychiatry (RANZCP), NSW Ministry of Health, Sydney, NSW, Australia
| | - Joanne Sharpe
- Joanne Sharpe, BAppSc (OT), NSW Ministry of Health, Sydney, NSW, Australia
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Di Lorenzo R, Cimino N, Di Pietro E, Pollutri G, Neviani V, Ferri P. A 5-year retrospective study of demographic, anamnestic, and clinical factors related to psychiatric hospitalizations of adolescent patients. Neuropsychiatr Dis Treat 2016; 12:191-201. [PMID: 26848268 PMCID: PMC4723031 DOI: 10.2147/ndt.s93874] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Psychiatric emergencies of children and adolescents have greatly increased during the last years, but this phenomenon has not been studied in detail. The aim of this study was to analyze the correlation between acute psychiatric hospitalizations of adolescents and selected variables to highlight risk factors for psychiatric emergencies. METHODS This retrospective research was conducted in the acute psychiatric public ward, Service of Psychiatric Diagnosis and Treatment (SPDT), and in the residential facility for adolescents, "The Medlar", located in Modena. The sample was constituted by all adolescent patients (n=101, age range 14-18) who had acute hospitalizations (n=140) in SPDT and had been successively transferred to "The Medlar" (n=83), from February 2, 2010 to January 31, 2015. From clinical charts, we extracted demographic and anamnestic characteristics of patients and clinical variables related to hospitalizations. Data were statistically analyzed. RESULTS Sixty-one percent of our patients lived with one divorced parent, with adoptive or immigrant family, or in institutions; 51% had experienced stressful events during childhood; 81% had a normal intellective level, but only 6% presented regular school performance. Parental psychiatric illness was negatively related, in a statistically significantly way, with onset age of adolescent mental disorders (coefficient -2.28, 95% confidence interval [CI]: -3.53 to 1.01, P<0.001, single linear regression; odds ratio: 4.39, 95% CI: 1.43-13.47, P<0.010, single logistic regression). The most frequent reasons for admission were aggressive behavior in males and suicide risk in females (P=0.002). The most frequent psychiatric diagnosis at SPDT discharge was "conduct disorder", more frequent in males, followed by "adjustment disorder", more frequent in females (P=0.001). In SPDT, the adolescent hospitalizations progressively increased fivefold at the end of the observation period. CONCLUSION Our results overlap the worldwide trend of increasing adolescent psychiatric hospitalizations, suggest risk factors like parental psychiatric illness and early life stressful events, and highlight the different prevalence of aggressiveness and suicide in males and females.
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Affiliation(s)
- Rosaria Di Lorenzo
- Service of Psychiatric Diagnosis and Treatment, Department of Mental Health, AUSL Modena, Modena, Italy
| | - Nina Cimino
- School of Nursing, University of Modena and Reggio Emilia, Italy
| | - Elena Di Pietro
- School of Neuro-Psychiatry, University of Modena and Reggio Emilia, Italy
| | | | | | - Paola Ferri
- School of Nursing, University of Modena and Reggio Emilia, Italy
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Stagi P, Galeotti S, Mimmi S, Starace F, Castagnini AC. Continuity of care from child and adolescent to adult mental health services: evidence from a regional survey in Northern Italy. Eur Child Adolesc Psychiatry 2015; 24:1535-41. [PMID: 26141538 DOI: 10.1007/s00787-015-0735-z] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/17/2014] [Accepted: 06/14/2015] [Indexed: 11/30/2022]
Abstract
To examine clinical and demographic factors associated with continuity of care from child-adolescent (CAMHS) to adult mental health services (AMHS), we undertook a record-linkage study to the Adult Mental Health Information System including all those 16 years old and over who were listed between 2010 and 2013 in the Child and Adolescent Neuropsychiatry Information System in Emilia-Romagna, an Italian region of nearly 4.5 million residents. From a cohort of 8239 adolescents attending CAMHS (population at risk about 144,000), 821 (19.4 %) moved to AMHS, excluding cases with specific developmental disorders, whose conditions were not managed by adult psychiatrists, and those with mental retardation who attended usually social services. Young people referred for treatment to AMHS were more likely to receive a discharge diagnosis of schizophrenia and related disorders (Odds Ratio [OR] 3.92; 95 % confidence interval [CI] 2.17-7.08), personality disorders (OR 2.69; 95 % CI 1.89-3.83), and pervasive developmental disorders (OR 2.13; 95 % CI 1.51-2.99). Further factors predicting transfer to AMHS were not living with parents, inpatient psychiatric admission, and being on medication in the previous 24 months. These findings suggest that a relatively small number of adolescents moved to AMHS and are likely to reflect the configuration of local mental health services and alternative care available, mainly for those with less-severe mental disorders.
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Affiliation(s)
- Paolo Stagi
- Mental Health Department, AUSL Modena, Modena, Italy. .,Child and Adolescent Neuropsychiatry Service, Mental Health Department, Azienda USL, Via A. Cardarelli 43, 41124, Modena, Italy.
| | | | - Stefano Mimmi
- Mental Health Department, AUSL Modena, Modena, Italy
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Pedrini L, Sisti D, Tiberti A, Preti A, Fabiani M, Ferraresi L, Palazzi S, Parisi R, Ricciutello C, Rocchi MBL, Squarcia A, Trebbi S, Tullini A, De Girolamo G. Reasons and pathways of first-time consultations at child and adolescent mental health services in Italy: an observational study. Child Adolesc Psychiatry Ment Health 2015; 9:29. [PMID: 26300965 PMCID: PMC4545546 DOI: 10.1186/s13034-015-0060-9] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/27/2014] [Accepted: 06/18/2015] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND An increasing number of young people have made contact with the Child and Adolescent Mental Health Services (CAMHS). However, only a small proportion of the population with emotional problems, actually seek specialized care. Research concerning the help-seeking process and pathways to care of a clinical sample could help to develop effective health policies to facilitate access to specialized care. AIM To analyze the access pattern for CAMHS, reasons of contact and care pathways of a consecutive sample of first-time patients. Our aim was to analyze the association between source of referral, socio-demographic and clinical variables. METHODS Standardized assessment instruments and information concerning access patterns and care pathways were collected from 399 patients at first-time contact with CAMHS in a Northern Italian Region. RESULTS Most patients were referred to CAMHS by school teachers (36 %) or health professionals (32 %), while only 17 % of the parents sought help by themselves. School issues (50 %) and emotional problems (17 %) were the most frequent reasons for contact. The proportion of first-time contacts with no diagnosis of mental disorder at their first consultation did not differ by source of referral. Parents of children who did not receive a clinical diagnosis of mental disorders described them as "psychosocially impaired" and their condition as "clinically severe" likewise parents of patients who received a psychiatric diagnosis. Patients with externalizing problems were more frequently referred by the parents themselves, while youth with internalizing problems were more often referred through health professionals. Families with non-traditional structures (adoptive, foster care, mono-parental) were more likely to consult CAMHS directly, while immigrant youth were more often referred by teachers. CONCLUSION Socio-demographic and clinical characteristics can affect pathways to care. To improve early access to care for children and adolescents with ongoing mental disorders, a plan for proper action addressed to teachers and health professionals may well be important. This would improve their ability to recognize emotional and behavioral problems and use proper referral pathways, while informative intervention addressed to non-Italian families should inform them about the functioning and the mission of CAMHS.
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Affiliation(s)
- Laura Pedrini
- IRCCS San Giovanni di Dio Fatebenefratelli di Brescia, via Pilastroni 4, Brescia, 25125 Italy
| | - Davide Sisti
- Dipartimento di Scienze Biomolecolari, Università degli Studi di Urbino “Carlo Bo”, Piazza Rinascimento 6, Urbino (PU), 61029 Italy
| | - Alessandra Tiberti
- Servizio Neuropsichiatria Infanzia e Adolescenza, Spedali Civili di Brescia, P.le Spedali Civili 1, Brescia, 25123 Italy
| | - Antonio Preti
- Centro di Psichiatria di Consulenza e Psicosomatica dell’ Azienda Ospedaliero Universitaria di Cagliari, via Ospedale, 09124 Cagliari, Italy ,Dipartimento di Pedagogia Psicologia e Filosofia, Università di Cagliari, Via Mirrionis 1, Cagliari, 09123 Italy
| | - Michela Fabiani
- UONPIA, AUSL di Reggio Emilia, Via Amendola 2, Reggio Emilia, 42100 Italy
| | - Linda Ferraresi
- UONPIA, AUSL di Modena, Via Alessandrini 2, Sassuolo, 41049 Italy
| | - Stefano Palazzi
- UONPIA, AUSL di Ferrara, via Messidoro 20, Ferrara, 44124 Italy
| | - Roberto Parisi
- UONPIA, AUSL di Piacenza, Corso Vittorio Emanuele 169, Piacenza, 29100 Italy
| | | | - Marco B. L. Rocchi
- Dipartimento di Scienze Biomolecolari, Università degli Studi di Urbino “Carlo Bo”, Piazza Rinascimento 6, Urbino (PU), 61029 Italy
| | | | - Stefano Trebbi
- NPI, Az. USL di Bologna, Via Crisalidi 2, Vado (Monzuno), BO 40036 Italy
| | - Andrea Tullini
- Servizio N.P.E.E., Az. USL di Rimini, Via Coriano 38, Rimini, 47921 Italy
| | - Giovanni De Girolamo
- IRCCS San Giovanni di Dio Fatebenefratelli di Brescia, via Pilastroni 4, Brescia, 25125 Italy
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Santos VD, Fernández A. Child and adolescent mental health services in Brazil: structure, use and challenges. REVISTA BRASILEIRA DE SAÚDE MATERNO INFANTIL 2014. [DOI: 10.1590/s1519-38292014000400002] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Objectives: to examine the state of Child and Adolescent Mental Health (CAMH) services and to compare the availability and use of CAMH services across the five regions of Brazil. Methods: the Mental Health Matrix Model was used as a framework to describe the state of CAMH services. Documents and administrative datasets were consulted, covering the whole country and the five Brazilian regions as separate levels. This enabled crossregion comparisons and combination with thethree temporal dimensions (Input, Process andOutcome) Results: although there are national policies regulating CAMH, along with an integral protection doctrine, scarcity of services was unequally distributed across the regions. A number of trends relating to social development and mental health (e.g. intellectual disability treated prevalence) were also identified. Conclusion: substantial advances in CAMH policy characterize the contemporary Brazilian CAMH system, especially regarding the implementa tion of community based mental health services for children and adolescents. However, the data reveals great inequalities and geographic variation regarding social indicators, service structure and use.
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