The Kidstime programme is an innovative attempt to address the particular needs of children and young people who have parents with mental illnesses. It comprises a monthly psycho-educational workshop involving discussions about the meaning of mental health, dramatizations of stories constructed by the children (often filmed), and concurrent parents’ groups, as well as joint seminars and review sessions. This paper presents a qualitative analysis of interviews with young people ( n=6) and parents ( n=5) attending the groups and interviews with former service users ( n=9). Five themes emerged from the thematic analysis: initial engagement, sharing with others, learning about mental health, opportunity for fun and impact on family relationships. Areas for further development were identified including the formation of a distinct adolescent Kidstime workshop to better meet their age-specific needs, and adjustments to the system for introducing new families to established workshop groups. Given the positive experience of the groups by those attending, a rigorous evaluation of the approach is suggested.
Background: Research suggests that there are differences in the problems that are referred to Child and Adolescent Mental Health Services (CAMHS) by White British and Asian families as well as differences in how these services are accessed. There is a need for more information about how different ethnic communities perceive and access CAMH services. Method: White British or Pakistani mothers of children between 0–20 years at an urban health centre were invited to complete a study‐specific questionnaire written in English (with verbal translation provided when needed). Data were collected on awareness and experience of, and willingness to use CAMH services; severity of problems before referral is considered and additional factors that influence service use. Results: In comparison to White British mothers, Pakistani mothers were found to be less likely to consider a referral for problems judged as mild or moderate. There was no difference for severe problems. Qualitative factors that would enhance the use of CAMH services by Pakistani mothers include the availability of culture and gender matched therapists, and better access to translation facilities. Conclusions: The study highlights service needs and expectations of mothers of Pakistani origin, and emphasises the need for relevant, inclusive and culturally sensitive services.
We report on a large, randomized controlled trial of a nationally-mandated, school-based mental health program in England: Targeted Mental Health in Schools (TaMHS). TaMHS aimed to improve mental health for students with, or at risk of, behavioral and emotional difficulties, by provision of evidence-informed interventions relating to closer working between health and education services. Our study involved 8,480 children (aged 8-9 years) from 266 elementary schools. Students in intervention schools with, or at risk of, behavioral difficulties reported significant reductions in behavioral difficulties compared to control school students, but no such difference was found for students with, or at risk of, emotional difficulties. Implementation of TaMHS was associated with increased school provision of a range of interventions and enhanced collaboration between schools and local specialist mental health providers. The implications of these findings are discussed, in addition to the strengths and limitations of the study
Evidence for the longitudinal associations between internalising symptom development and academic attainment is sparse and results from existing studies are largely inconclusive. The approaches that have been used in existing studies examining this relationship have in common the limitation of grouping together all individuals in the sample which makes the assumption that the relationship between time, symptoms and attainment across all individuals is the same. The current study aimed to use heterogeneous trajectories of symptom development to examine the longitudinal associations between internalising symptom development and change in academic attainment over a three years period in early adolescence, a key period for internalising symptom development. Internalising symptoms were assessed for 3 consecutive years in a cohort from age 11–14 years (n = 2647, mean age at T1 = 11.7 years). National standardised test scores prior to the first wave and subsequent to the last wave were used as measures of academic attainment. Heterogeneous symptom development trajectories were identified using latent class growth analysis and socio-demographic correlates, such as gender, SES and ethnicity, of the different trajectory groupings were investigated. Derived trajectory groupings were examined as predictors of subsequent academic attainment, controlling for prior attainment. Results demonstrate that symptom trajectories differentially predicted change in academic attainment with increasing trajectories associated with significantly worse academic outcomes when compared to pupils with low levels of symptoms in all waves. Hence, a trajectory based approach provides a more nuanced breakdown of complexities in symptom development and their differential relationships with academic outcomes and in doing so helps clarify the longitudinal relationship between these two key domains of functioning in early adolescence.
Background Establishing what constitutes clinically significant change is important both for reviewing the function of services and for reflecting on individual clinical practice. A range of methods for assessing change exist, but it remains unclear which are best to use and under which circumstances. Method This paper reviews four indices of change [difference scores ( DS ), crossing clinical threshold ( CCT ), reliable change index ( RCI ) and added value scores ( AVS )] drawing on outcome data for 9764 young people from child and adolescent mental health services across England. Results Looking at DS , the t ‐test for time one to time two scores indicated a significant difference between baseline and follow up scores, with a standardised effect size of d = 0.40. AVS analysis resulted in a smaller effect size of 0.12. Analysis of those crossing the clinical threshold showed 21.2% of cases were classified as recovered, while 5.5% were classified as deteriorated. RCI identified 16.5% of cases as showing reliable improvement and 2.3% of cases as showing reliable deterioration. Across RCI and CCT 80.5% of the pairings were exact (i.e., identified in the same category using each method). Conclusions Findings indicate that the level of agreement across approaches is at least moderate; however, the estimated extent of change varied to some extent based on the index used. Each index may be appropriate for different contexts: CCT and RCI may be best suited to use for individual case review; whereas DS and AVS may be more appropriate for case‐mix adjusted national reporting.
We need better tools to achieve the next generation reforms essential for delivering care that matters most to patients, say Albert Mulley and colleagues
Healthcare economies across the globe are in crisis. High income countries—whether their healthcare economies are market driven like the US or tax funded like the UK—are struggling with relentless demand for more services that are increasingly costly to deliver. Low and middle income countries are struggling to provide better and more equitable access to potentially lifesaving interventions while wisely allocating scarce resources across all sectors that affect human and social development. In rich and poor countries alike, policy makers, citizens, and health professionals are drawn to technology but are not learning how to use it most effectively or from mistakes made when its limits go unrecognised or unheeded.1
Variation in regional rates of therapeutic and diagnostic interventions and hospital based care exists globally with no measurable benefit in populations receiving more services.2345 At the same time effective primary healthcare and social services that can have a greater effect on health and wellbeing are being underused.467 The failure to deliver the right care at the right time in the right place contributes to the waste of as much as 40% of healthcare expenditures.48
Recognition of this waste, which is often associated with harm to patients, has spurred health policy reforms across the globe. One common objective is people centred care, which focuses on the needs and wants of individuals and engages them in management of their own care, including behaviours that promote and sustain health and wellbeing. A policy forum held earlier this year, which included health ministers and other representatives from members of the Organisation for Economic Cooperation and Development and seven other countries, advocated a …
The possibility of harm from mental health provision, and in particular harm from youth mental health provision, has been largely overlooked. We contend that if we continue to assume youth mental health services can do no harm, and all that is needed is more services, we continue to risk the possibility that the safety of children and young people is unintentionally compromised. We propose a three level framework for considering harm from youth mental health provision (1. ineffective engagement, 2. ineffective practice and 3. adverse events) and suggest how this framework could be used to support quality improvement in services.
'%3e%3cpath fill='%23012169' d='M0 0v30h60V0z'/%3e%3cpath stroke='%23fff' stroke-width='6' d='m0 0 60 30m0-30L0 30'/%3e%3cpath stroke='%23C8102E' stroke-width='4' d='m0 0 60 30m0-30L0 30' clip-path='url(%23b)'/%3e%3cpath stroke='%23fff' stroke-width='10' d='M30 0v30M0 15h60'/%3e%3cpath stroke='%23C8102E' stroke-width='6' d='M30 0v30M0 15h60'/%3e%3c/g%3e%3c/svg%3e)
'%3e%3cg id='b'%3e%3cpath id='a' d='M0-8v8h4z' transform='rotate(18 0 -8)'/%3e%3cuse xlink:href='%23a' transform='scale(-1 1)'/%3e%3c/g%3e%3cuse xlink:href='%23b' transform='rotate(72)'/%3e%3cuse xlink:href='%23b' transform='rotate(144)'/%3e%3cuse xlink:href='%23b' transform='rotate(216)'/%3e%3cuse xlink:href='%23b' transform='rotate(288)'/%3e%3c/g%3e%3c/svg%3e)