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Koochakpour K, Nytrø Ø, Leventhal BL, Sverre Westbye O, Brox Røst T, Koposov R, Frodl T, Clausen C, Stien L, Skokauskas N. A review of information sources and analysis methods for data driven decision aids in child and adolescent mental health services. Int J Med Inform 2024; 188:105479. [PMID: 38761460 DOI: 10.1016/j.ijmedinf.2024.105479] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2023] [Revised: 06/16/2023] [Accepted: 05/08/2024] [Indexed: 05/20/2024]
Abstract
OBJECTIVE Clinical data analysis relies on effective methods and appropriate data. Recognizing distinctive clinical services and service functions may lead to improved decision-making. Our first objective is to categorize analytical methods, data sources, and algorithms used in current research on information analysis and decision support in child and adolescent mental health services (CAMHS). Our secondary objective is to identify the potential for data analysis in different clinical services and functions in which data-driven decision aids can be useful. MATERIALS AND METHODS We searched related studies in Science Direct and PubMed from 2018 to 2023(Jun), and also in ACM (Association for Computing Machinery) Digital Library, DBLP (Database systems and Logic Programming), and Google Scholar from 2018 to 2021. We have reviewed 39 studies and extracted types of analytical methods, information content, and information sources for decision-making. RESULTS In order to compare studies, we developed a framework for characterizing health services, functions, and data features. Most data sets in reviewed studies were small, with a median of 1,550 patients and 46,503 record entries. Structured data was used for all studies except two that used textual clinical notes. Most studies used supervised classification and regression. Service and situation-specific data analysis dominated among the studies, only two studies used temporal, or process features from the patient data. This paper presents and summarizes the utility, but not quality, of the studies according to the care situations and care providers to identify service functions where data-driven decision aids may be relevant. CONCLUSIONS Frameworks identifying services, functions, and care processes are necessary for characterizing and comparing electronic health record (EHR) data analysis studies. The majority of studies use features related to diagnosis and assessment and correspondingly have utility for intervention planning and follow-up. Profiling the disease severity of referred patients is also an important application area.
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Affiliation(s)
- Kaban Koochakpour
- Department of Computer Science, Norwegian University of Science and Technology (NTNU), Trondheim, Norway.
| | - Øystein Nytrø
- Department of Computer Science, Norwegian University of Science and Technology (NTNU), Trondheim, Norway; Department of Computer Science, The Arctic University of Norway (UiT), Tromsø, Norway
| | | | - Odd Sverre Westbye
- Regional Centre for Child and Youth Mental Health and Child Welfare (RKBU Central Norway), Department of Mental Health, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology (NTNU), Trondheim, Norway; Department of Child and Adolescent Psychiatry, St. Olav's University Hospital, Trondheim, Norway
| | | | - Roman Koposov
- Regional Centre for Child and Youth Mental Health and Child Welfare (RKBU), The Arctic University of Norway (UiT), Tromsø, Norway
| | - Thomas Frodl
- Department of Psychiatry, Psychotherapy and Psychosomatics, RWTH Aachen University, Aachen, Germany
| | - Carolyn Clausen
- Regional Centre for Child and Youth Mental Health and Child Welfare (RKBU Central Norway), Department of Mental Health, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology (NTNU), Trondheim, Norway
| | - Line Stien
- Regional Centre for Child and Youth Mental Health and Child Welfare (RKBU Central Norway), Department of Mental Health, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology (NTNU), Trondheim, Norway
| | - Norbert Skokauskas
- Regional Centre for Child and Youth Mental Health and Child Welfare (RKBU Central Norway), Department of Mental Health, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology (NTNU), Trondheim, Norway
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Kelleher KJ, Gardner W, Kemper AR, Chavez L, Pajer K, Rosic T. Principles for Primary Care Screening in the Context of Population Health. Acad Pediatr 2024:S1876-2859(24)00073-1. [PMID: 38458490 DOI: 10.1016/j.acap.2024.02.015] [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: 06/26/2023] [Revised: 11/16/2023] [Accepted: 02/29/2024] [Indexed: 03/10/2024]
Abstract
A key component of primary care pediatrics is health promotion through screening: applying a test or procedure to detect a previously unrecognized disease or disease risk. How do we decide whether to screen? In 1965, Wilson and Jungner published an influential set of screening principles focused on the health problem's importance, the screening tool's performance, and the evidence for treatment efficacy. However, if we want realistic estimates of the population effects of routine screening, we must also account for the healthcare system's real-world functioning and disparities in care. We offer revised principles to guide discussions about routine screening in the primary care setting. We add to Wilson and Jungner's principles: 1. A focus on life course epidemiology and its consequences for population health, 2. A need to screen for the early stages of chronic health problems, 3. A concern for screening's acceptability to providers and the community, 4. A recommendation for estimating the uncertainty in benefits and harms in evaluating screening, 5. Inclusion of systematic plans for population data collection and monitoring, and 6. Recognition that achieving population health improvement requires a high-performing system with sufficient throughput and monitoring to deliver accessible, affordable, and effective care, especially for the groups experiencing the greatest inequities in access. Above all, instead of assuming best practices in treatment delivery and monitoring after screening, we argue for realism about the healthcare system functioning in routine practice. WHAT'S NEW: We update Wilson and Jungner's (1965) principles for routine screening. If we want realistic estimates of the population effects of routine screening, we must consider not just screening accuracy and efficacy but also the healthcare system's real-world functioning and inequities.
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Affiliation(s)
- Kelly J Kelleher
- Department of Pediatrics, The Ohio State University, and The Abigail Wexner Research Institute Nationwide Children's Hospital. 700 Children's Drive, Columbus, OH 43205 United States.
| | - William Gardner
- School of Epidemiology and Public Health and CHEO Research Institute. 401 Smyth Rd, Ottawa, ON Canada K1H 5B2.
| | - Alex R Kemper
- Department of Pediatrics, The Ohio State University, and The Abigail Wexner Research Institute Nationwide Children's Hospital.
| | - Laura Chavez
- Department of Pediatrics, The Ohio State University, and The Abigail Wexner Research Institute Nationwide Children's Hospital.
| | - Kathleen Pajer
- Department of Psychiatry, University of Ottawa, and CHEO Research Institute. 401 Smyth Rd, Ottawa, ON Canada K1H 5B2.
| | - Tea Rosic
- Children's Hospital of Eastern Ontario. 401 Smyth Rd, Ottawa, ON K1H 8L1 Canada.
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3
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Jukes LM, Di Folco S, Kearney L, Sawrikar V. Barriers and Facilitators to Engaging Mothers and Fathers in Family-Based Interventions: A Qualitative Systematic Review. Child Psychiatry Hum Dev 2024; 55:137-151. [PMID: 35763177 PMCID: PMC10796537 DOI: 10.1007/s10578-022-01389-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/28/2022] [Indexed: 11/03/2022]
Abstract
The current systematic review examined the similarities and differences between mothers' and fathers' reported barriers and facilitators to engaging in family-based interventions for child and adolescent behavioural problems (aged 2-17 years). Systematic searches of six electronic databases and grey literature alongside a two-way screening process identified twenty eligible qualitative studies from 2004 to 2019. A thematic meta-synthesis identified similarities in major themes of psychological, situational, knowledge/awareness, programme/intervention, co-parenting, practitioner, and beliefs/attitudes factors, alongside group experiences and stages of engagement. However, differences emerged in subthemes related to parental, treatment, and service delivery factors that included individual ideologies of parenting, parental roles, and treatment participation; the role of mothers in facilitating engagement; and individual preferences for treatment content and delivery. Overall, findings suggest that while mothers and fathers experience similar challenges to engagement, they can also experience distinct challenges which need to be addressed at the treatment outset to maximise engagement.
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Affiliation(s)
- Laura M Jukes
- School of Health in Social Science, The University of Edinburgh, Edinburgh, Scotland, UK
- National Health Service (NHS) Lothian, Edinburgh, Scotland, UK
| | - Simona Di Folco
- School of Health in Social Science, The University of Edinburgh, Edinburgh, Scotland, UK
- National Health Service (NHS) Lothian, Edinburgh, Scotland, UK
| | - Lisa Kearney
- School of Health in Social Science, The University of Edinburgh, Edinburgh, Scotland, UK
- National Health Service (NHS) Lothian, Edinburgh, Scotland, UK
| | - Vilas Sawrikar
- School of Health in Social Science, The University of Edinburgh, Edinburgh, Scotland, UK.
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4
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Ribeiro WS, Romeo R, King D, Owens S, Gronholm PC, Fisher HL, Laurens KR, Evans-Lacko S. Influence of stigma, sociodemographic and clinical characteristics on mental health-related service use and associated costs among young people in the United Kingdom. Eur Child Adolesc Psychiatry 2023; 32:1363-1373. [PMID: 35088184 PMCID: PMC10326138 DOI: 10.1007/s00787-022-01947-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/16/2021] [Accepted: 01/11/2022] [Indexed: 11/03/2022]
Abstract
This study examined the influence of stigma, psychopathology, and sociodemographic characteristics on mental health-related service use and costs related to service use in a cohort of young people in the UK. Using data from a community sample of young people aged 9-17 years and their caregivers, we assessed 407 young people's use of services due to mental health problems, young people's psychopathology, demographic characteristics, maternal education and caregivers' stigma-related beliefs. Unit costs related to services were gathered from national annual compendia and other widely used sources. We assessed predictors of service use through logistic regression analysis and developed generalised linear models to identify factors associated with costs of mental health-related service utilisation. Persistent psychopathology, socioeconomic disadvantage, and low caregiver intended stigma-related behaviour were associated with increased likelihood of service use among young people. Older age and socioeconomic disadvantage were associated with increased costs. Different factors influenced contact with services and the cost associated with their use - persistent psychopathology and socioeconomic disadvantage increased, and caregivers' intended stigma-related behaviour decreased the likelihood of using services, whereas socioeconomic disadvantage and older age were associated with increased costs. Social determinants of mental health problems play an important role in the use and costs of different types of mental health-related services for young people. Discordance between drivers of service use and costs implies that young people who are more likely to access services due to mental health problems do not necessarily receive care at the intensity they need.
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Affiliation(s)
- Wagner Silva Ribeiro
- Care Policy and Evaluation Centre, London School of Economics and Political Science, Houghton Street, London, WC2A 2AE, UK.
| | - Renee Romeo
- Health Service and Population Research Department, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
| | - Derek King
- Care Policy and Evaluation Centre, London School of Economics and Political Science, Houghton Street, London, WC2A 2AE, UK
| | | | - Petra C Gronholm
- Health Service and Population Research Department, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
| | - Helen L Fisher
- Social, Genetic & Developmental Psychiatry Centre, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
- ESRC Centre for Society and Mental Health, King's College London, London, UK
| | - Kristin R Laurens
- School of Psychology and Counselling, Queensland University of Technology (QUT), Brisbane, Australia
- Department of Psychosis Studies, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
| | - Sara Evans-Lacko
- Care Policy and Evaluation Centre, London School of Economics and Political Science, Houghton Street, London, WC2A 2AE, UK
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5
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Banwell E, Qualter P, Humphrey N. Barriers and facilitators to training delivery and subsequent implementation of a localised child and adolescent mental health initiative: a qualitative content analysis. BMC MEDICAL EDUCATION 2023; 23:264. [PMID: 37076849 PMCID: PMC10113980 DOI: 10.1186/s12909-023-04238-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/16/2022] [Accepted: 04/06/2023] [Indexed: 05/03/2023]
Abstract
BACKGROUND Ensuring that children and young people (CYP) can obtain mental health support from a broad variety of sources is of upmost importance. This is especially true given the increasing prevalence of mental health difficulties in this population, and the associated challenges with receiving support from specialised healthcare services. Equipping professionals, from a wide range of sectors, with the skills needed to provide this support is a vital starting point. This study explored the experiences of professionals who had participated in CYP mental health training modules that related directly to the local implementation of the THRIVE Framework for System Change in Greater Manchester, UK (GM i-THRIVE) to establish the perceived barriers and facilitators behind the implementation of this training programme. METHODS Directed qualitative content analysis of semi-structured interview data from nine CYP-facing professionals was conducted. Both the interview schedule and initial deductive coding strategy were developed using the findings of a systematic literature review by the authors, that was conducted to explore wider CYP mental health training experiences. This methodology was used to establish the presence or absence of these findings within GM i-THRIVE, before generating tailored recommendations for their training programme. RESULTS When the interview data were coded and analysed, a strong level of thematic similarity with the authors' review was found. However, we deduced that the emergence of additional themes might reflect the contextual uniqueness of GM i-THRIVE, that is likely to be further compounded by the COVID-19 pandemic. Six recommendations were made for further improvement. These included the facilitation of unstructured peer interaction during training, and ensuring that jargon and key words are fully clarified. CONCLUSIONS Methodological limitations, guidance for usage, and potential applications of the study's findings are explored. Whilst the findings were largely akin to those of the review, subtle yet important differences were found. These are likely to reflect the nuances of the training programme discussed, however, we tentatively suggest that our findings are transferable to similar training interventions. This study provides a valuable example of how qualitative evidence syntheses can be used to aid study design and analysis: an underused approach.
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Affiliation(s)
- Emily Banwell
- Institute of Education, University of Manchester, Ellen Wilkinson Building, Manchester, M13 9PL, UK.
| | - Pamela Qualter
- Institute of Education, University of Manchester, Ellen Wilkinson Building, Manchester, M13 9PL, UK
| | - Neil Humphrey
- Institute of Education, University of Manchester, Ellen Wilkinson Building, Manchester, M13 9PL, UK
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6
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Hansen AS, Kjaersdam Telléus G, Mohr-Jensen C, Færk E, Lauritsen MB. The effect of the Development and Well-Being Assessment as an adjunct to standard referral letters on referral decisions by child and adolescent mental health services - a randomized feasibility trial. Clin Child Psychol Psychiatry 2023; 28:434-449. [PMID: 35337193 DOI: 10.1177/13591045221081384] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Background: High rejection rates for referrals to child and adolescent mental health services (CAMHS) are common. The most cited reasons for rejection are that the child does not have a clinical need for assessment and poor quality of the referrals. However, studies of interventions aimed at improving appropriateness of referrals are sparse. Methods: In this randomized feasibility trial, we tested if the Development and Well-Being Assessment (DAWBA) as an adjunct to referral letters could improve accuracy of referral decisions made by CAMHS. The primary outcome of the study was the proportion of "correct" referral decisions. Results: The study included 160 children referred to CAMHS. Almost all (95.6%) participants fulfilled criteria for a mental disorder and 82.1% also reported high impact of symptoms. Compared to the group who did not complete the DAWBA, referral decisions for the DAWBA group showed higher sensitivity (0.63 vs. 0.83), specificity (0.30 vs. 0.42), and negative predictive value (0.14 vs. 0.36) as well as slightly higher positive predictive value (0.81 vs. 0.86). Conclusions: The use of the DAWBA as an adjunct to standard referral letters could lead to more correct referral decisions and reduce the proportion of wrongful rejection referrals to CAMHS.
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Affiliation(s)
- Anna Sofie Hansen
- Department of Psychiatry, 53141Aalborg University Hospital, Aalborg, Denmark.,Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
| | - Gry Kjaersdam Telléus
- Department of Psychiatry, 53141Aalborg University Hospital, Aalborg, Denmark.,Institute of Communication and Psychology, Aalborg University, Aalborg, Denmark
| | - Christina Mohr-Jensen
- Department of Psychiatry, 53141Aalborg University Hospital, Aalborg, Denmark.,Institute of Communication and Psychology, Aalborg University, Aalborg, Denmark
| | - Emil Færk
- Department of Psychiatry, 53141Aalborg University Hospital, Aalborg, Denmark
| | - Marlene Briciet Lauritsen
- Department of Psychiatry, 53141Aalborg University Hospital, Aalborg, Denmark.,Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
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7
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Graf D, Lerch S, Böhnke U, Reichl C, Kindler J, Koenig J, Kaess M. Treatment outcome of an intensive psychiatric home treatment for children and adolescents: a non-randomized controlled pilot evaluation. Eur Child Adolesc Psychiatry 2023; 32:685-695. [PMID: 34853908 PMCID: PMC8635478 DOI: 10.1007/s00787-021-01919-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/21/2021] [Accepted: 11/19/2021] [Indexed: 12/29/2022]
Abstract
Home treatment (HT) may offer an effective and cost-efficient alternative to inpatient treatment for children and adolescents with acute mental disorders. This study introduces and evaluates a pilot HT project from Bern, Switzerland, with HT completely replacing an inpatient treatment. A total of n = 133 children and adolescents with acute mental disorders and inpatient treatment needs were treated either in the new HT program (n = 37) or in an active control group with inpatient treatment as usual (I-TAU, n = 96). Psychopathological burden was assessed by the Health of the Nation Outcome Scale for Children and Adolescents clinician-rated (HoNOSCA) and self-rated (HoNOSCA-SR) at the time of admission and at discharge. Treatment effects were assessed and compared using Augmented Inverse Probability Weights to adjust for baseline differences and to control for treatment duration. Participants ranged in age from 6 to 17 years (M = 13.71 years, SD = 2.93), 54% were female. HT resulted in significant improvements in the HoNOSCA (d = 0.79, p < .001) and HoNOSCA-SR (d = 0.63, p = .006). No significant differences on treatment effects were observed between HT and the reference group I-TAU in the HoNOSCA (d = 0.01, p = .96) or the HoNOSCA-SR (d = 0.11, p = .63). Overall, results indicate HT to be an effective alternative for children and adolescents with acute mental health disorders instead of hospitalization. Further evaluation with random group allocation and long-term follow-up should attempt to replicate and extend the current findings.
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Affiliation(s)
- Daniel Graf
- University Hospital of Child and Adolescent Psychiatry and Psychotherapy, University of Bern, Bern, Switzerland
| | - Stefan Lerch
- University Hospital of Child and Adolescent Psychiatry and Psychotherapy, University of Bern, Bern, Switzerland
| | - Ulrich Böhnke
- University Hospital of Child and Adolescent Psychiatry and Psychotherapy, University of Bern, Bern, Switzerland
| | - Corinna Reichl
- University Hospital of Child and Adolescent Psychiatry and Psychotherapy, University of Bern, Bern, Switzerland
| | - Jochen Kindler
- University Hospital of Child and Adolescent Psychiatry and Psychotherapy, University of Bern, Bern, Switzerland
| | - Julian Koenig
- University Hospital of Child and Adolescent Psychiatry and Psychotherapy, University of Bern, Bern, Switzerland
- Department of Child and Adolescent Psychiatry, Center for Psychosocial Medicine, University of Heidelberg, Heidelberg, Germany
- Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Michael Kaess
- University Hospital of Child and Adolescent Psychiatry and Psychotherapy, University of Bern, Bern, Switzerland.
- Department of Child and Adolescent Psychiatry, Center for Psychosocial Medicine, University of Heidelberg, Heidelberg, Germany.
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Ball WP, Black C, Gordon S, Ostrovska B, Paranjothy S, Rasalam A, Ritchie D, Rowlands H, Rzewuska M, Thompson E, Wilde K, Butler JE. Inequalities in children's mental health care: analysis of routinely collected data on prescribing and referrals to secondary care. BMC Psychiatry 2023; 23:22. [PMID: 36627578 PMCID: PMC9831880 DOI: 10.1186/s12888-022-04438-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/30/2022] [Accepted: 11/30/2022] [Indexed: 01/12/2023] Open
Abstract
BACKGROUND One in eight children in the United Kingdom are estimated to have a mental health condition, and many do not receive support or treatment. The COVID-19 pandemic has negatively impacted mental health and disrupted the delivery of care. Prevalence of poor mental health is not evenly distributed across age groups, by sex or socioeconomic groups. Equity in access to mental health care is a policy priority but detailed socio-demographic trends are relatively under-researched. METHODS We analysed records for all mental health prescriptions and referrals to specialist mental health outpatient care between the years of 2015 and 2021 for children aged 2 to 17 years in a single NHS Scotland health board region. We analysed trends in prescribing, referrals, and acceptance to out-patient treatment over time, and measured differences in treatment and service use rates by age, sex, and area deprivation. RESULTS We identified 18,732 children with 178,657 mental health prescriptions and 21,874 referrals to specialist outpatient care. Prescriptions increased by 59% over the study period. Boys received double the prescriptions of girls and the rate of prescribing in the most deprived areas was double that in the least deprived. Mean age at first mental health prescription was almost 1 year younger in the most deprived areas than in the least. Referrals increased 9% overall. Initially, boys and girls both had an annual referral rate of 2.7 per 1000, but this fell 6% for boys and rose 25% for girls. Referral rate for the youngest decreased 67% but increased 21% for the oldest. The proportion of rejected referrals increased steeply since 2020 from 17 to 30%. The proportion of accepted referrals that were for girls rose to 62% and the mean age increased 1.5 years. CONCLUSIONS The large increase in mental health prescribing and changes in referrals to specialist outpatient care aligns with emerging evidence of increasing poor mental health, particularly since the start of the COVID-19 pandemic. The static size of the population accepted for specialist treatment amid greater demand, and the changing demographics of those accepted, indicate clinical prioritisation and unmet need. Persistent inequities in mental health prescribing and referrals require urgent action.
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Affiliation(s)
- William P Ball
- Aberdeen Centre for Health Data Science, University of Aberdeen, Aberdeen, Scotland
| | - Corri Black
- Aberdeen Centre for Health Data Science, University of Aberdeen, Aberdeen, Scotland.,NHS Grampian, Aberdeen, Scotland
| | - Sharon Gordon
- Aberdeen Centre for Health Data Science, University of Aberdeen, Aberdeen, Scotland
| | - Bārbala Ostrovska
- Aberdeen Centre for Health Data Science PPIE Group, Aberdeen, Scotland
| | - Shantini Paranjothy
- Aberdeen Centre for Health Data Science, University of Aberdeen, Aberdeen, Scotland.,NHS Grampian, Aberdeen, Scotland
| | | | | | - Helen Rowlands
- Aberdeen Centre for Health Data Science, University of Aberdeen, Aberdeen, Scotland
| | - Magdalena Rzewuska
- Health Services Research Unit, University of Aberdeen, Aberdeen, Scotland
| | | | - Katie Wilde
- Grampian Data Safe Haven (DaSH), University of Aberdeen, Aberdeen, Scotland
| | - Jessica E Butler
- Aberdeen Centre for Health Data Science, University of Aberdeen, Aberdeen, Scotland.
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9
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Banwell E, Humphrey N, Qualter P. Reformed child and adolescent mental health services in a devolved healthcare system: a mixed-methods case study of an implementation site. FRONTIERS IN HEALTH SERVICES 2023; 3:1112544. [PMID: 37213205 PMCID: PMC10196272 DOI: 10.3389/frhs.2023.1112544] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 11/30/2022] [Accepted: 04/17/2023] [Indexed: 05/23/2023]
Abstract
Background Efforts are being made to reform and reconceptualise children and young people's (CYP) mental health services. This is in response to a rapid increase in mental health difficulties in this population, and the shortcomings of current service provision. The present study seeks to comprehensively evaluate the local implementation of the THRIVE Framework for System Change in Greater Manchester, UK (GM i-THRIVE) from 2018 to 2021. The framework was designed to change the way mental health is perceived, and subsequently how support is allocated. The current study focusses on the implementation of the framework's principles into CYP mental health support in the region. Methods The study comprised three methodological components, beginning with examination of the GM i-THRIVE implementation plan and self-assessment questionnaire measure using the Quality Implementation Tool. This was to provide a wider backdrop of implementation method adequacy to the rest of the study's findings. Subsequently, evaluation measures completed by professionals across Greater Manchester were examined to establish implementation progress, before corroborating key items from this measure with thematically analysed interview data from six CYP (13-22 years) who recently received mental health support in the region. Levels of agreement between staff and CYP were examined. Results GM i-THRIVE's implementation plan and self-assessment measure were respectively deemed a strong guiding foundation, and a suitable way of evaluating implementation progress. Every principle within the self-assessment measure demonstrated closer alignment with the THRIVE Framework as time progressed. Two themes were developed from the qualitative interview data, each overarching four subthemes: (1) Qualities of the service: information and decision sharing; communication and continuity; needs-based support; compassion and trust, and (2) The mental health journey: beginnings; endings; waiting; satisfaction with support. A good level of agreement between CYP testimony and staff progress reports was found. Conclusions Findings suggested that the experiences of the CYP in the sample, who were interviewed in the spring to summer period of 2022, were overwhelmingly positive. The rich insights into mental health support offered by the young participants lead us to recommend continued qualitative research with service-users as GM i-THRIVE's embedding period continues, with focus on representing a wide range of experiences in future research samples. Methodological limitations were explored, including the extent to which true cross-references could be made between professional and CYP accounts.
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Wright B, Tindall L, Scott AJ, Lee E, Biggs K, Cooper C, Bee P, Wang HI, Gega L, Hayward E, Solaiman K, Teare MD, Davis T, Lovell K, Wilson J, McMillan D, Barr A, Edwards H, Lomas J, Turtle C, Parrott S, Teige C, Chater T, Hargate R, Ali S, Parkinson S, Gilbody S, Marshall D. One-session treatment compared with multisession CBT in children aged 7–16 years with specific phobias: the ASPECT non-inferiority RCT. Health Technol Assess 2022; 26:1-174. [DOI: 10.3310/ibct0609] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
Background
Up to 10% of children and young people have a specific phobia that can significantly affect their mental health, development and daily functioning. Cognitive–behavioural therapy-based interventions remain the dominant treatment, but limitations to their provision warrant investigation into low-intensity alternatives. One-session treatment is one such alternative that shares cognitive–behavioural therapy principles but has a shorter treatment period.
Objective
This research investigated the non-inferiority of one-session treatment to cognitive–behavioural therapy for treating specific phobias in children and young people. The acceptability and cost-effectiveness of one-session treatment were examined.
Design
A pragmatic, multicentre, non-inferiority randomised controlled trial, with embedded economic and qualitative evaluations.
Settings
There were 26 sites, including 12 NHS trusts.
Participants
Participants were aged 7–16 years and had a specific phobia defined in accordance with established international clinical criteria.
Interventions
Participants were randomised 1 : 1 to receive one-session treatment or usual-care cognitive–behavioural therapy, and were stratified according to age and phobia severity. Outcome assessors remained blind to treatment allocation.
Main outcome measures
The primary outcome measure was the Behavioural Avoidance Task at 6 months’ follow-up. Secondary outcomes included the Anxiety Disorder Interview Schedule, Child Anxiety Impact Scale, Revised Children’s Anxiety and Depression Scale, a goal-based outcome measure, Child Health Utility 9D, EuroQol-5 Dimensions Youth version and resource usage. Treatment fidelity was assessed using the Cognitive Behaviour Therapy Scale for Children and Young People and the One-Session Treatment Rating Scale.
Results
A total of 274 participants were recruited, with 268 participants randomised to one-session treatment (n = 134) or cognitive–behavioural therapy (n = 134). A total of 197 participants contributed some data, with 149 participants in the intention-to-treat analysis and 113 in the per-protocol analysis. Mean Behavioural Avoidance Task scores at 6 months were similar across treatment groups when both intention-to-treat and per-protocol analyses were applied [cognitive–behavioural therapy: 7.1 (intention to treat), 7.4 (per protocol); one-session treatment: 7.4 (intention to treat), 7.6 (per protocol); on the standardised scale adjusted mean difference for cognitive–behavioural therapy compared with one-session treatment –0.123, 95% confidence interval –0.449 to 0.202 (intention to treat), mean difference –0.204, 95% confidence interval –0.579 to 0.171 (per protocol)]. These findings were wholly below the standardised non-inferiority limit of 0.4, which suggests that one-session treatment is non-inferior to cognitive–behavioural therapy. No between-group differences in secondary outcome measures were found. The health economics evaluation suggested that, compared with cognitive–behavioural therapy, one-session treatment marginally decreased the mean service use costs and maintained similar mean quality-adjusted life-year improvement. Nested qualitative evaluation found one-session treatment to be considered acceptable by those who received it, their parents/guardians and clinicians. No adverse events occurred as a result of phobia treatment.
Limitations
The COVID-19 pandemic meant that 48 children and young people could not complete the primary outcome measure. Service waiting times resulted in some participants not starting therapy before follow-up.
Conclusions
One-session treatment for specific phobia in UK-based child mental health treatment centres is as clinically effective as multisession cognitive–behavioural therapy and highly likely to be cost-saving. Future work could involve improving the implementation of one-session treatment through training and commissioning of improved care pathways.
Trial registration
This trial is registered as ISRCTN19883421.
Funding
This project was funded by the National Institute for Health and Care Research (NIHR) Health Technology Assessment programme and will be published in full in Health Technology Assessment; Vol. 26, No. 42. See the NIHR Journals Library website for further project information.
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Affiliation(s)
- Barry Wright
- COMIC Research Team, Leeds and York Partnership NHS Foundation Trust, Leeds, UK
- Mental Health and Addictions Research Group, Hull York Medical School, University of York, York, UK
| | - Lucy Tindall
- COMIC Research Team, Leeds and York Partnership NHS Foundation Trust, Leeds, UK
| | | | - Ellen Lee
- Sheffield Clinical Trials Research Unit, School of Health and Related Research (ScHARR), University of Sheffield, Sheffield, UK
| | - Katie Biggs
- Sheffield Clinical Trials Research Unit, School of Health and Related Research (ScHARR), University of Sheffield, Sheffield, UK
| | - Cindy Cooper
- Sheffield Clinical Trials Research Unit, School of Health and Related Research (ScHARR), University of Sheffield, Sheffield, UK
| | - Penny Bee
- School of Nursing, Midwifery and Social Care, University of Manchester, Manchester, UK
| | - Han-I Wang
- Centre for Health Economics, University of York, York, UK
| | - Lina Gega
- Mental Health and Addictions Research Group, Hull York Medical School, University of York, York, UK
| | - Emily Hayward
- COMIC Research Team, Leeds and York Partnership NHS Foundation Trust, Leeds, UK
| | - Kiera Solaiman
- Sheffield Clinical Trials Research Unit, School of Health and Related Research (ScHARR), University of Sheffield, Sheffield, UK
| | - M Dawn Teare
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
| | - Thompson Davis
- Department of Psychology, Louisiana State University, Baton Rouge, LA, USA
| | - Karina Lovell
- School of Nursing, Midwifery and Social Care, University of Manchester, Manchester, UK
| | - Jon Wilson
- Central Norfolk Youth Service, Norfolk and Suffolk NHS Foundation Trust, Norwich, UK
| | - Dean McMillan
- Centre for Health Economics, University of York, York, UK
| | - Amy Barr
- Sheffield Clinical Trials Research Unit, School of Health and Related Research (ScHARR), University of Sheffield, Sheffield, UK
| | - Hannah Edwards
- COMIC Research Team, Leeds and York Partnership NHS Foundation Trust, Leeds, UK
| | - Jennifer Lomas
- Sheffield Clinical Trials Research Unit, School of Health and Related Research (ScHARR), University of Sheffield, Sheffield, UK
| | - Chris Turtle
- Sheffield Clinical Trials Research Unit, School of Health and Related Research (ScHARR), University of Sheffield, Sheffield, UK
| | - Steve Parrott
- Centre for Health Economics, University of York, York, UK
| | - Catarina Teige
- COMIC Research Team, Leeds and York Partnership NHS Foundation Trust, Leeds, UK
| | - Tim Chater
- Sheffield Clinical Trials Research Unit, School of Health and Related Research (ScHARR), University of Sheffield, Sheffield, UK
| | - Rebecca Hargate
- COMIC Research Team, Leeds and York Partnership NHS Foundation Trust, Leeds, UK
| | - Shehzad Ali
- Mental Health and Addictions Research Group, Hull York Medical School, University of York, York, UK
| | - Sarah Parkinson
- COMIC Research Team, Leeds and York Partnership NHS Foundation Trust, Leeds, UK
| | - Simon Gilbody
- Mental Health and Addictions Research Group, Hull York Medical School, University of York, York, UK
| | - David Marshall
- Centre for Reviews and Dissemination, University of York, York, UK
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Williamson V, Larkin M, MacDonald I, Morgan F, Ford T, Spence SH, Reardon T, Creswell C. Primary school based mental health practitioners’ perspectives of school-based screening for childhood mental disorders and intervention delivery: A qualitative study. EMOTIONAL AND BEHAVIOURAL DIFFICULTIES 2022. [DOI: 10.1080/13632752.2022.2110704] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
Affiliation(s)
- Victoria Williamson
- Department of Experimental Psychology, Anna Watts Building, University of Oxford, Oxford
- Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London
- Oxford University Hospitals NHS Foundation Trust, Oxford, UK
- Department of Psychiatry, Warneford Hospital, Warneford Ln, Headington, Oxford
| | - Michael Larkin
- Aston Institute for Health & Neurodevelopment, Department of Psychology, Aston University, Birmingham, UK
| | | | | | - Tamsin Ford
- Department of Psychiatry, University of Cambridge, Cambridge, UK
| | - Susan H. Spence
- School of Applied Psychology and Australian Institute of Suicide Research and Prevention, Griffith University, Brisbane, Queensland, Australia
| | - Tessa Reardon
- Department of Experimental Psychology, Anna Watts Building, University of Oxford, Oxford
- Oxford University Hospitals NHS Foundation Trust, Oxford, UK
- Department of Psychiatry, Warneford Hospital, Warneford Ln, Headington, Oxford
| | - Cathy Creswell
- Department of Experimental Psychology, Anna Watts Building, University of Oxford, Oxford
- Oxford University Hospitals NHS Foundation Trust, Oxford, UK
- Department of Psychiatry, Warneford Hospital, Warneford Ln, Headington, Oxford
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12
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Sawrikar V, Macbeth A, Gillespie-Smith K, Brown M, Lopez-Williams A, Boulton K, Guestella A, Hickie I. Transdiagnostic Clinical Staging for Childhood Mental Health: An Adjunctive Tool for Classifying Internalizing and Externalizing Syndromes that Emerge in Children Aged 5-11 Years. Clin Child Fam Psychol Rev 2022; 25:613-626. [PMID: 35598197 PMCID: PMC9427921 DOI: 10.1007/s10567-022-00399-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/03/2022] [Indexed: 11/20/2022]
Abstract
Clinical staging is now recognized as a key tool for facilitating innovation in personalized and preventative mental health care. It places a strong emphasis on the salience of indicated prevention, early intervention, and secondary prevention of major mental disorders. By contrast to established models for major mood and psychotic syndromes that emerge after puberty, developments in clinical staging for childhood-onset disorders lags significantly behind. In this article, criteria for a transdiagnostic staging model for those internalizing and externalizing disorders that emerge in childhood is presented. This sits alongside three putative pathophysiological profiles (developmental, circadian, and anxious-arousal) that may underpin these common illness trajectories. Given available evidence, we argue that it is now timely to develop a transdiagnostic staging model for childhood-onset syndromes. It is further argued that a transdiagnostic staging model has the potential to capture more precisely the dimensional, fluctuating developmental patterns of illness progression of childhood psychopathology. Given potential improvements in modelling etiological processes, and delivering more personalized interventions, transdiagnostic clinical staging for childhood holds much promise for assisting to improve outcomes. We finish by presenting an agenda for research in developments of transdiagnostic clinical staging for childhood mental health.
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Affiliation(s)
- Vilas Sawrikar
- Centre of Applied Developmental Psychology, University of Edinburgh, Edinburgh, UK.
- Department of Clinical & Health Psychology, School of Health in Social Sciences, The University of Edinburgh, Medical School (Doorway 6), Room 1M.8, Teviot Place, Edinburgh, EH8 9AG, UK.
| | - Angus Macbeth
- Centre of Applied Developmental Psychology, University of Edinburgh, Edinburgh, UK
- Department of Clinical & Health Psychology, School of Health in Social Sciences, The University of Edinburgh, Medical School (Doorway 6), Room 1M.8, Teviot Place, Edinburgh, EH8 9AG, UK
| | - Karri Gillespie-Smith
- Centre of Applied Developmental Psychology, University of Edinburgh, Edinburgh, UK
- Department of Clinical & Health Psychology, School of Health in Social Sciences, The University of Edinburgh, Medical School (Doorway 6), Room 1M.8, Teviot Place, Edinburgh, EH8 9AG, UK
| | - Megan Brown
- ADHD & Autism Psychological Services and Advocacy, Utica, NY, USA
| | | | - Kelsie Boulton
- Brain and Mind Centre, University of Sydney, Sydney, Australia
| | - Adam Guestella
- Brain and Mind Centre, University of Sydney, Sydney, Australia
| | - Ian Hickie
- Brain and Mind Centre, University of Sydney, Sydney, Australia
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13
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'You're on the waiting list': An interpretive phenomenological analysis of young adults' experiences of waiting lists within mental health services in the UK. PLoS One 2022; 17:e0265542. [PMID: 35303040 PMCID: PMC8932552 DOI: 10.1371/journal.pone.0265542] [Citation(s) in RCA: 20] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2021] [Accepted: 03/03/2022] [Indexed: 11/20/2022] Open
Abstract
Waiting lists in mental health services are currently considered too long. Lengthy waits of up to 18 weeks are commonly reported in the UK. Waiting lists have long been associated with a variety of negative psychological responses, however there is little understanding behind young adults’ personal experiences of such delays within mental health services. The current study aimed to explore young adults’ experiences of waiting lists in mental healthcare in the UK. Seven young adults were interviewed in the current study (aged 19–22). Interpretive phenomenological analysis was utilised to explore participant accounts. Three super-ordinate themes were generated: Reliance on Alternative Methods of Support; Inability to Function Sufficiently; and Emergence of Negative Beliefs, Emotions and Thoughts. Participants primarily reported a variety of negative psychological and behavioural consequences associated with waiting lists in mental health services, as well as exacerbated existing physical and psychological health issues. In accordance with the limited number of previous studies, waiting lists are considered by patients to be barriers to mental health support and intervention. Future direction is advised.
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14
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Hansen AS, Christoffersen CH, Telléus GK, Lauritsen MB. Referral patterns to outpatient child and adolescent mental health services and factors associated with referrals being rejected. A cross-sectional observational study. BMC Health Serv Res 2021; 21:1063. [PMID: 34625073 PMCID: PMC8501731 DOI: 10.1186/s12913-021-07114-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2021] [Accepted: 10/01/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Outpatient child and adolescent mental health services (CAMHS) are faced with the challenge of balancing increasing demands with limited resources. An additional challenge is high rejection rates of referrals which causes frustration for referring agents and families. In order to effectively plan and allocate available resources within CAMHS there is a need for up-to-date knowledge on referral patterns and factors associated with rejection of referrals. METHODS In this cross-sectional observational study we did a retrospective review of all referrals (n = 1825) for children (0-18) referred for assessment at the outpatient CAMHS of the North Denmark Region in 2018. RESULTS The most common referral reasons to CAMHS were attention deficit disorder (ADHD/ADD) (27.9%), autism spectrum disorder (22.4%), affective disorders (14.0%) and anxiety disorders (11.6%). The majority of referrals came from general practitioners, but for neurodevelopmental disorders educational psychologists were the primary referral source. Re-referrals constituted more than a third of all referrals (35.9%). Children in care were overrepresented in this clinical sample and had an increased risk (Adj. OR 2.54) of having their referrals rejected by CAMHS. Referrals from general practitioners were also associated with an increased risk of rejection (Adj. OR 3.29). CONCLUSIONS A high proportion of children with mental disorders have a repeated need for assessment by CAMHS. There is a need for future research on predictors of re-referral to outpatient services to identify potential targets for reducing re-referral rates as well as research on how to optimize service provision for children with a repeated need for assessment. General practitioners are the main gatekeepers to CAMHS and research on interventions to improve the referral process should be aimed towards general practitioners.
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Affiliation(s)
- Anna Sofie Hansen
- Aalborg University Hospital, Psychiatry, Mølleparkvej 10, 9000, Aalborg, Denmark. .,Department of Clinical Medicine, Aalborg University, Sdr. Skovvej 15, 9000, Aalborg, Denmark.
| | | | - Gry Kjaersdam Telléus
- Aalborg University Hospital, Psychiatry, Mølleparkvej 10, 9000, Aalborg, Denmark.,Psychology, Department of Communication and Psychology, Aalborg University, Rendsburggade 14, 9000, Aalborg, Denmark
| | - Marlene Briciet Lauritsen
- Aalborg University Hospital, Psychiatry, Mølleparkvej 10, 9000, Aalborg, Denmark.,Department of Clinical Medicine, Aalborg University, Sdr. Skovvej 15, 9000, Aalborg, Denmark
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15
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Gibbons N, Harrison E, Stallard P. Making sense of child and adolescent mental health services (CAMHS): An audit of the referral journey and the use of routine outcome measures (ROMS). Clin Child Psychol Psychiatry 2021; 26:760-769. [PMID: 33706555 DOI: 10.1177/1359104521999709] [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] [Indexed: 11/17/2022]
Abstract
BACKGROUND There is increased emphasis on the national reporting of Routine Outcome Measures (ROMS) as a way of improving Child and Adolescent Mental Health Services (CAMHS). This data needs to be viewed in context so that reasons for outcome completion rates are understood and monitored over time. METHOD We undertook an in-depth prospective audit of consecutive referrals accepted into the Bath and North East Somerset, Swindon and Wiltshire (BSW) CAMHS service from November 2017 to January 2018 (n = 1074) and April to September 2019 (n = 1172). RESULTS Across both audits 90% of those offered an appointment were seen with three quarters completing baseline ROMS. One in three were not seen again with around 30% still being open to the service at the end of each audit. Of those closed to the service, paired ROMS were obtained for 46% to 60% of cases. There were few changes in referral problems or complexity factors over time. CONCLUSION Understanding the referral journey and the reasons for attrition will help to put nationally collected data in context and can inform and monitor service transformation over time.
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Affiliation(s)
- Naomi Gibbons
- Child and Family Mental Health, Oxford Health National Health Service Foundation Trust, Melksham Community Hospital, Melksham, UK
| | - Emma Harrison
- Child and Family Mental Health, Oxford Health National Health Service Foundation Trust, Melksham Community Hospital, Melksham, UK
| | - Paul Stallard
- Child and Adolescent Mental Health Group, Department for Health, University of Bath, Bath, UK.,Child and Family Mental Health, Temple House, Oxford Health National Health Service Foundation Trust, Keynsham, UK
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16
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Albutt A, Berzins K, Louch G, Baker J. Health professionals' perspectives of safety issues in mental health services: A qualitative study. Int J Ment Health Nurs 2021; 30:798-810. [PMID: 33728730 DOI: 10.1111/inm.12838] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/05/2020] [Revised: 11/04/2020] [Accepted: 12/20/2020] [Indexed: 11/29/2022]
Abstract
The study aimed to explore mental health professionals' perceptions of patient safety issues across community and inpatient mental health services. Fourteen mental health professionals across community and inpatient settings participated in qualitative interviews. Framework analysis, guided by the Yorkshire Contributory Factors Framework - Mental Health, was used to analyse the data. Safety issues identified by mental health professionals mapped on to 19 of the 21 factors in the Yorkshire Contributory Factors Framework - Mental Health. The factors most frequently mentioned by participants were 'safety culture' which focused on raising concerns, learning from incidents and the influence of targets; 'communication systems' to support effective communication between staff; 'service user factors' including a perceived increase in illness acuity; 'service process' including how patients access and interact with services; and 'staff workload' perceived being as unmanageable. Mental health professionals consider there to be a broad range of safety issues associated with mental health services. Future research should aim to develop interventions to improve safety focused across the factors raised by professionals.
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Affiliation(s)
- Abigail Albutt
- Yorkshire Quality and Safety Research Group, Bradford Institute for Health Research, Bradford Royal Infirmary, Bradford, UK
| | | | - Gemma Louch
- Yorkshire Quality and Safety Research Group, Bradford Institute for Health Research, Bradford Royal Infirmary, Bradford, UK
| | - John Baker
- School of Healthcare, University of Leeds, Leeds, UK
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17
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Parent-directed intervention versus controls whilst their child waits for diagnostic assessment: a systematic review protocol. Syst Rev 2021; 10:67. [PMID: 33663597 PMCID: PMC7931343 DOI: 10.1186/s13643-021-01615-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/01/2020] [Accepted: 02/17/2021] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Waiting lists are an ongoing issue for publicly funded community and hospital-based health services. Parents and caregivers are instrumental supports in the health and well-being of young and school-aged children, yet little is known about the way they can be supported during waiting periods. Given mounting evidence about the value of early intervention in physical and mental health literature, and waits for some public health services extending past 12 months, it is both timely and warranted to explore interim interventions that may be applied in this period. METHODS Intervention studies that have applied an educational programme, information, group-based support or individualised therapy to primary caregivers of children (heron referred to as parent-directed interventions), waiting for diagnostic assessment at any inpatient or outpatient health service and aged between 1 and 12 years of age, will be reviewed. These will include intervention studies of any type that have included more than 5 participants or participant groups and where a control or comparison group has been included. Abstract screening, full-text review, data extraction and risk of bias will be conducted by two reviewers. Relevant databases in health and education will be systematically searched using key words and Medical Subject Headings (MeSH) and grey literature will be explored. Databases will include PubMed, Ovid for MEDLINE and PsycINFO, EBSCO for the Cumulative Index of Nursing and Allied Health Literature (CINAHL), and the Education Resources Information Center (ERIC). Covidence© will be used to support abstract and full text screening, which will be completed by two main reviewers. Results will be tabulated, summarised and meta-analysed using a random-effects model, in any instance where concordant outcome measures have been applied. Results will be published and reported in line with PRISMA reporting guidelines. DISCUSSION Given little is known about effective support for families when children are awaiting diagnostic assessment for any medical, developmental or behavioural condition, the authors will synthesise existing evidence about parent-directed interventions in this period. It is hoped that by understanding the existing evidence interventions that are proven to be effective will be adopted and intervention innovation can occur. SYSTEMATIC REVIEW REGISTRATION PROSPERO 2020 CRD42020159360.
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18
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Banwell E, Humphrey N, Qualter P. Delivering and implementing child and adolescent mental health training for mental health and allied professionals: a systematic review and qualitative meta-aggregation. BMC MEDICAL EDUCATION 2021; 21:103. [PMID: 33588821 PMCID: PMC7885386 DOI: 10.1186/s12909-021-02530-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/15/2020] [Accepted: 01/29/2021] [Indexed: 05/02/2023]
Abstract
BACKGROUND The increasing prevalence of mental health difficulties among children and young people (CYP) suggests that early intervention is vital. A comprehensive system of care and support requires the involvement of mental health professionals, including psychologists and psychiatrists, and allied professionals, including teachers, police, and youth workers. A critical starting point is the provision of effective training, in order that these professionals can better support the mental health needs of the CYP that they encounter. OBJECTIVES Given the primacy of training in the CYP mental health support system, understanding the factors that maximise potential gains and facilitate uptake is pertinent. The current review therefore located and explored qualitative research evidence, to identify the barriers and facilitators underpinning successful delivery and implementation of training focussed on the mental health of CYP, for both mental health and allied professionals. METHODS A systematic review and qualitative meta-aggregation were conducted. Systematic searches were carried out using ASSIA, EMBASE, MEDLINE, NICE Evidence, PsycINFO, and Scopus databases, for papers published between 2000 and 2020. Twelve thousand four hundred forty-eight records were identified, of which 39 were eligible for review. The records were appraised for quality using the Joanna Briggs Institute Critical Appraisal Checklist for Qualitative Research, and synthesised using the qualitative meta-aggregation method. RESULTS One hundred eighty-two raw findings were extracted from the 39 papers, which were condensed into 47 sub-categories, 19 categories, and finally 5 synthesis statements. These synthesis statements reflected the barriers and facilitators influencing the training delivery process ("support"; "content, design, and planning"), and the implementation of training into the workplace ("context"; "perceived value"; "organisational factors"). CONCLUSIONS The synthesis statements and underlying categories provide practical recommendations for those designing, delivering, or implementing CYP mental health training. Recommendations ranged from facilitating peer support during training, to the idea that training will be better implemented when perceived need is high. The review provides a robust evidence-based foundation to "common-sense" principles, drawing them into a coherent and organised framework using a synthesis method grounded in pragmatism. PROTOCOL REGISTRATION NUMBER PROSPERO reference ID: CRD42020162876.
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Affiliation(s)
- Emily Banwell
- Institute of Education, University of Manchester, Ellen Wilkinson Building, Manchester, M13 9PL UK
| | - Neil Humphrey
- Institute of Education, University of Manchester, Ellen Wilkinson Building, Manchester, M13 9PL UK
| | - Pamela Qualter
- Institute of Education, University of Manchester, Ellen Wilkinson Building, Manchester, M13 9PL UK
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19
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Parent-perceived barriers to accessing services for their child's mental health problems. Child Adolesc Psychiatry Ment Health 2021; 15:4. [PMID: 33514400 PMCID: PMC7847149 DOI: 10.1186/s13034-021-00357-7] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/27/2020] [Accepted: 01/11/2021] [Indexed: 01/14/2023] Open
Abstract
BACKGROUND Many children and adolescents with impairing mental health disorders are not in contact with specialized child and adolescent mental health services (CAMHS). In order to close the service gap, it is important to increase our knowledge of barriers to access. The aim of this study was to investigate parent perceived barriers to accessing services for their child's mental health problems to identify potential areas for improvement of access to CAMHS. METHOD In this cross-sectional observational study 244 parents of children and adolescents referred to outpatient psychiatric assessment were interviewed using the Children's services interview regarding barriers to accessing child mental health services across healthcare, educational services and social services. Parent reported barriers were analyzed in relation to the child's age, referral reason, symptom duration and impairment of the child. RESULTS The most commonly reported barriers were lack of information about were to seek help (60.3%), the perception that professionals did not listen (59.8%) and professionals refusing to initiate interventions or provide referral to services (53.7%). Lack of knowledge, stigmatization and unavailability of services were common themes across barriers to help-seeking. Long symptom duration and parent rated impairment was associated with increased risk of reporting several barriers to help-seeking. CONCLUSION Parents seeking help for their child's mental health encounter numerous barriers that could explain part of the treatment gap and long duration of mental health problems in children prior to referral to CAMHS.
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20
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Palman J, McDonagh JE. Young Minds: Mental Health and Transitional Care in Adolescent and Young Adult Rheumatology. Open Access Rheumatol 2020; 12:309-321. [PMID: 33324121 PMCID: PMC7732171 DOI: 10.2147/oarrr.s228083] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2020] [Accepted: 11/11/2020] [Indexed: 12/27/2022] Open
Abstract
Consideration of the mental health and emotional wellbeing is an important component of health care for all young people, irrespective of setting. Mental health disorders are common during adolescence and young adulthood and young people with rheumatic musculoskeletal diseases (RMD) are not exempt. For such young people, risks of poor outcomes are related to both mental health as well as their RMD. Times of change during adolescence and young adulthood-transitions-are potentially vulnerable life stages for young people with RMD and warrant specific attention in health care provision. Such transitions include those occurring at puberty, during education, training, and employment, socially with moves away from the parental home, as well as from child to adult-centered health services. There is great potential for rheumatology professionals to support young people with RMD at these transitions in view of their frequent encounters and ongoing therapeutic relationships. In this review, we aim to assess the impact of mental health on RMD during adolescence and young adulthood with particular reference to transitional care provision and how rheumatology professionals can be involved in addressing mental health issues during this time of change.
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Affiliation(s)
- Jason Palman
- Department of Paediatric and Adolescent Rheumatology, Royal Manchester Children’s Hospital, Manchester University Hospitals NHS Trust, ManchesterM13 9WL, UK
| | - Janet E McDonagh
- Department of Paediatric and Adolescent Rheumatology, Royal Manchester Children’s Hospital, Manchester University Hospitals NHS Trust, ManchesterM13 9WL, UK
- Versus Arthritis Centre for Epidemiology; Centre for MSK Research, University of Manchester, Manchester, UK
- NIHR Biomedical Research Centre, Manchester University Hospital NHS Trust, Manchester, UK
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21
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Abstract
BACKGROUND Access to timely care is a quality standard underpinning many international healthcare models, and long waiting times for child and adolescent mental health services are often reported as a barrier to help-seeking. AIMS The aim of this study was to examine whether young people with more severe problems have shorter waiting times for mental health services. METHOD Multilevel multinomial regression analysis controlling for service-area deprivation, age, gender, ethnicity, referral source and contextual factors was conducted on N = 21 419 episodes of care (mean age 12.37 years (s.d. = 3.71), 11 712 (55%) female) using data from child and adolescent mental health services. RESULTS There was high variation in waiting times, which ranged from 0 days to 1629 days (mean 50.65 days (s.d. = 78.03), median 32 days). Compared with young people with less severe problems young people with severe problems, self-harm, psychosis or eating disorders were less likely to experience longer waiting times. Moreover, referrals from sources other than primary care were generally less likely to have longer waiting times than referrals from primary care sources, especially referral from accident and emergency services. CONCLUSIONS The findings suggest that young people with more severe problems had shorter waiting times. Intermediary information and resources for support before access to services is needed to prevent escalation of problems and to support individuals and families while waiting for care. Interventions to reduce waiting times should be considered without compromising on the quality and experience of care that young people and families deserve when seeking help.
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Affiliation(s)
- Julian Edbrooke-Childs
- Evidence Based Practice Unit, University College London & Anna Freud National Centre for Children and Families, Clinical, Educational and Health Psychology, UK
| | - Jessica Deighton
- Evidence Based Practice Unit, University College London & Anna Freud National Centre for Children and Families, Clinical, Educational and Health Psychology, UK
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22
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Graaf G, Snowden L. State Strategies for Enhancing Access and Quality in Systems of Care for Youth with Complex Behavioral Health Needs. ADMINISTRATION AND POLICY IN MENTAL HEALTH AND MENTAL HEALTH SERVICES RESEARCH 2020; 48:185-200. [PMID: 32638137 DOI: 10.1007/s10488-020-01061-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
The investigators conducted a qualitative study with state administrators and policymakers about the financing and policies that structure public systems of care for children with complex behavioral healthcare needs. The objective was to characterize diverse strategies states employed to enhance funding for, access to, and quality and effectiveness of home and community-based services (HCBS) for these youth. States report using a wide variety of creative solutions while navigating the unique needs and constraints of their political and economic environments. Findings can benefit public officials, researchers, and advocates by advancing knowledge-sharing of public policy-making and resourceful problem-solving.
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Affiliation(s)
- Genevieve Graaf
- School of Social Work, University of Texas At Arlington, Social Work Complex - A, 112D, 211 South Cooper Street, Box 19129, Arlington, TX, 76019, USA.
| | - Lonnie Snowden
- School of Public Health, University of California, Berkeley, USA
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Shafran R, Bennett S, Coughtrey A, Welch A, Walji F, Cross JH, Heyman I, Sibelli A, Smith J, Ross J, Dalrymple E, Varadkar S, Moss-Morris R. Optimising Evidence-Based Psychological Treatment for the Mental Health Needs of Children with Epilepsy: Principles and Methods. Clin Child Fam Psychol Rev 2020; 23:284-295. [PMID: 31965422 PMCID: PMC7192863 DOI: 10.1007/s10567-019-00310-3] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
There are potent evidence-based psychological treatments for youth with mental health needs, yet they are rarely implemented in clinical practice, especially for youth with mental health disorders in the context of chronic physical illness such as epilepsy. Implementation science, the study of the translation of research into practice, can promote the uptake of existing effective interventions in routine clinical practice and aid the sustainable integration of psychological treatments with routine health care. The aim of this report was to use four implementation science methods to develop a version of an existing effective psychological treatment for mental health disorders [the Modular Approach to Treatment of Children with Anxiety, Depression or Conduct Problems (MATCH-ADTC)] for use within paediatric epilepsy services: (a) literature search; (b) iterative focus groups underpinned by normalisation process theory; (c) Plan-Do-Study-Act methods; and (d) qualitative patient interviews. Findings: Three modifications were deemed necessary to facilitate implementation in children with both mental health disorders and epilepsy. These were (a) a universal brief psychoeducational component addressing the relationship between epilepsy and mental health; (b) supplementary, conditionally activated interventions addressing stigma, parental mental health and the transition to adulthood; and (c) additional training and supervision. The intervention needed relatively little alteration for implementation in paediatric epilepsy services. The modified treatment reflected the scientific literature and the views of clinicians and service users. The multi-method approach used in this report can serve as a model for implementation of evidence-based psychological treatments for children with mental health needs in the context of other chronic illnesses.
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Affiliation(s)
- Roz Shafran
- Population, Policy and Practice Research and Teaching Department, University College London Great Ormond Street Institute of Child Health, 30 Guilford Street, London, WC1N 1EH, UK.
- Great Ormond Street Hospital NHS Foundation Trust, Great Ormond Street, London, WC1N 3JH, UK.
| | - Sophie Bennett
- Population, Policy and Practice Research and Teaching Department, University College London Great Ormond Street Institute of Child Health, 30 Guilford Street, London, WC1N 1EH, UK
- Great Ormond Street Hospital NHS Foundation Trust, Great Ormond Street, London, WC1N 3JH, UK
| | - Anna Coughtrey
- Population, Policy and Practice Research and Teaching Department, University College London Great Ormond Street Institute of Child Health, 30 Guilford Street, London, WC1N 1EH, UK
- Great Ormond Street Hospital NHS Foundation Trust, Great Ormond Street, London, WC1N 3JH, UK
| | - Alice Welch
- Population, Policy and Practice Research and Teaching Department, University College London Great Ormond Street Institute of Child Health, 30 Guilford Street, London, WC1N 1EH, UK
- Great Ormond Street Hospital NHS Foundation Trust, Great Ormond Street, London, WC1N 3JH, UK
| | - Fahreen Walji
- Population, Policy and Practice Research and Teaching Department, University College London Great Ormond Street Institute of Child Health, 30 Guilford Street, London, WC1N 1EH, UK
- Great Ormond Street Hospital NHS Foundation Trust, Great Ormond Street, London, WC1N 3JH, UK
| | - J Helen Cross
- Population, Policy and Practice Research and Teaching Department, University College London Great Ormond Street Institute of Child Health, 30 Guilford Street, London, WC1N 1EH, UK
- Great Ormond Street Hospital NHS Foundation Trust, Great Ormond Street, London, WC1N 3JH, UK
| | - Isobel Heyman
- Population, Policy and Practice Research and Teaching Department, University College London Great Ormond Street Institute of Child Health, 30 Guilford Street, London, WC1N 1EH, UK
- Great Ormond Street Hospital NHS Foundation Trust, Great Ormond Street, London, WC1N 3JH, UK
| | - Alice Sibelli
- Health Psychology, Institute of Psychiatry, Psychology and Neuroscience, Kings College London, London, SE1 9RT, UK
| | | | - Jamie Ross
- Department of Primary Care and Population Health, UCL Medical School (Royal Free Campus), University College London, Rowland Hill Street, London, NW3 2PF, UK
| | - Emma Dalrymple
- Population, Policy and Practice Research and Teaching Department, University College London Great Ormond Street Institute of Child Health, 30 Guilford Street, London, WC1N 1EH, UK
| | - Sophia Varadkar
- Great Ormond Street Hospital NHS Foundation Trust, Great Ormond Street, London, WC1N 3JH, UK
| | - Rona Moss-Morris
- Health Psychology, Institute of Psychiatry, Psychology and Neuroscience, Kings College London, London, SE1 9RT, UK
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Wright B, Tindall L, Hargate R, Allgar V, Trépel D, Ali S. Computerised cognitive-behavioural therapy for depression in adolescents: 12-month outcomes of a UK randomised controlled trial pilot study. BJPsych Open 2019; 6:e5. [PMID: 31829300 PMCID: PMC7001485 DOI: 10.1192/bjo.2019.91] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/11/2018] [Revised: 05/20/2019] [Accepted: 11/12/2019] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND Computerised cognitive-behavioural therapy (CCBT) in the care pathway has the potential to improve access to psychological therapies and reduce waiting lists within Child and Adolescent Mental Health Services, however, more randomised controlled trials (RCTs) are needed to assess this. AIMS This single-centre RCT pilot study compared a CCBT program (Stressbusters) with an attention control (self-help websites) for adolescent depression at referral to evaluate the clinical and cost-effectiveness of CCBT (trial registration: ISRCTN31219579). METHOD The trial ran within community and clinical settings. Adolescents (aged 12-18) presenting to their primary mental health worker service for low mood/depression support were assessed for eligibility at their initial appointment, 139 met inclusion criteria (a 33-item Mood and Feelings Questionnaire score of ≥20) and were randomised to Stressbusters (n = 70) or self-help websites (n = 69) using remote computerised single allocation. Participants completed mood, quality of life (QoL) and resource-use measures at intervention completion, and 4 and 12 months post-intervention. Changes in self-reported measures and completion rates were assessed by group. RESULTS There was no significant difference between CCBT and the website group at 12 months. Both showed improvements on all measures. QoL measures in the intervention group showed earlier improvement compared with the website group. Costs were lower in the intervention group but the difference was not statistically significant. The cost-effectiveness analysis found just over a 65% chance of Stressbusters being cost-effective compared with websites. The 4-month follow-up results from the initial feasibility study are reported separately. CONCLUSIONS CCBT and self-help websites may both have a place in the care pathway for adolescents with depression.
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Affiliation(s)
- Barry Wright
- Chair in Child Mental Health, Hull York Medical School, University of York & Leeds and York Partnership NHS Foundation Trust, UK
| | - Lucy Tindall
- Research Fellow, Leeds and York Partnership NHS Foundation Trust, UK
| | - Rebecca Hargate
- Research Manager, Leeds and York Partnership NHS Foundation Trust, UK
| | - Victoria Allgar
- Professor in Medical Statistics, Hull York Medical School, University of York, UK
| | - Dominic Trépel
- Health Economist, Department of Health Sciences, University of York, UK
| | - Shehzad Ali
- Health Economist, Department of Health Sciences, University of York, UK
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Bonati M, Cartabia M, Zanetti M. Waiting times for diagnosis of attention-deficit hyperactivity disorder in children and adolescents referred to Italian ADHD centers must be reduced. BMC Health Serv Res 2019; 19:673. [PMID: 31533711 PMCID: PMC6751639 DOI: 10.1186/s12913-019-4524-0] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2019] [Accepted: 09/10/2019] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND To investigate timely access to and the time needed to complete the diagnostic path of children and adolescents with suspected attention deficit hyperactivity disorder (ADHD) in the 18 Italian Lombardy Region ADHD reference centers. METHODS Data of children and adolescents enrolled in the Regional ADHD disease-oriented Registry for suspected ADHD who requested their first visit in 2013-2017 were analyzed. RESULTS The sample comprised 2262 children and adolescents aged 5-17 years who accessed the ADHD centers for diagnostic classification and management. The median waiting time was of 177 days (range 66-375) from the request for the initial appointment to the completion of the diagnostic path, with a three - fold difference between centers. In addition to the center, the strongest significant predictors of long waiting times were age comorbidities, the severity of the disorder, and having already completed some diagnostic procedures provided by the common standard path. CONCLUSIONS To guarantee an equal standard of care in ADHD centers for all children and adolescents there is a pressing need to reduce the times to complete the diagnostic path. It is the task of both policymakers and each center to optimize the quality of the service and of the care delivered.
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Affiliation(s)
- Maurizio Bonati
- Laboratory for Mother Child Health, Department of Public Health, Istituto di Ricerche Farmacologiche Mario Negri IRCCS, Via Giuseppe La Masa 19, 20156, Milan, Italy.
| | - Massimo Cartabia
- Laboratory for Mother Child Health, Department of Public Health, Istituto di Ricerche Farmacologiche Mario Negri IRCCS, Via Giuseppe La Masa 19, 20156, Milan, Italy
| | - Michele Zanetti
- Laboratory for Mother Child Health, Department of Public Health, Istituto di Ricerche Farmacologiche Mario Negri IRCCS, Via Giuseppe La Masa 19, 20156, Milan, Italy
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Longridge R, Norman S, Henley W, Newlove Delgado T, Ford T. Investigating the agreement between the clinician and research diagnosis of attention deficit hyperactivity disorder and how it changes over time; a clinical cohort study. Child Adolesc Ment Health 2019; 24:133-141. [PMID: 32677186 DOI: 10.1111/camh.12285] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 05/08/2018] [Indexed: 11/29/2022]
Abstract
BACKGROUND Attention Deficit Hyperactivity Disorder (ADHD) is a common reason for referral to Child and Adolescent Mental Health Services (CAMHS), but families experience long delays between first professional contact and diagnosis, which risks development of secondary impairments. This study explores the agreement between clinician and research diagnoses of ADHD among children attending CAMHS, and their access to interventions. From the limited literature, we anticipated fluctuation and delays, but no other study has focused prospectively on ADHD diagnoses. METHODS This was a secondary analysis of a cohort of children attending two CAMHS between 2006 and 2009. The sample included 288 consecutive referrals of children aged between 5 and 11 years. Parents and teachers completed the Development and Well-Being Assessment (DAWBA) when the child was recruited to the study, which provided the research diagnosis of ADHD from the baseline. Clinicians reported no, possible, or definite diagnosis of ADHD and interventions provided at 6-monthly intervals for up to 2 years while the child attended CAMHS. We assessed agreement between the diagnoses using Kendall's Tau-B. RESULTS Of the 101 children with a research diagnosis of ADHD, 26 received a definite clinician diagnosis during 2-year follow-up, and 47 received a possible clinician diagnosis. The chance-corrected agreement was poor at all time points (Kendall's Tau-B 0.14-0.48). Clinician diagnoses were unstable, particularly if possible ADHD was recorded at the initial assessment. Of those with a research diagnosis, 15 were prescribed medication and 11 were offered parent training. CONCLUSIONS The use of standardised diagnostic assessments could reduce diagnostic uncertainty and increase access to evidence-based interventions.
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Affiliation(s)
| | - Shelley Norman
- Child Health Research Group, University of Exeter, Exeter, UK
| | | | | | - Tamsin Ford
- Child Health Research Group, University of Exeter, Exeter, UK
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School-based early intervention for anxiety and depression in older adolescents: A feasibility randomised controlled trial of a self-referral stress management workshop programme ("DISCOVER"). J Adolesc 2019; 71:150-161. [PMID: 30738219 DOI: 10.1016/j.adolescence.2018.11.009] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2018] [Revised: 11/29/2018] [Accepted: 11/30/2018] [Indexed: 12/17/2022]
Abstract
INTRODUCTION Schools may provide a convenient intervention setting for young people with mental health problems generally, as well as for those who are unwilling or unable to access traditional clinic-based mental health services. However, few studies focus on older adolescents, or those from ethnic minority groups. This study aims to assess the feasibility of a brief school-based psychological intervention for self-referred adolescents aged 16-19 years. METHODS A two-arm cluster randomised controlled trial was conducted in 10 inner-city schools with block randomisation of schools. The intervention comprised a one-day CBT Stress management programme with telephone follow-up (DISCOVER) delivered by 3 psychology (2 clinical and 1 assistant) staff. The control was a waitlist condition. Primary outcomes were depression (Mood and Feelings Questionnaire; MFQ) and anxiety (Revised Child Anxiety and Depression Scale; RCADS-anxiety subscale). Data were analysed descriptively and quantitatively to assess feasibility. RESULTS 155 students were enrolled and 142 (91.6%) followed up after 3 months. Participants were predominantly female (81%) and the mean age was 17.3 years, with equal numbers enrolled from Year 12 and Year 13. Over half (55%) of students were from ethnic minority groups. Intraclass correlations were low. Variance estimates were calculated to estimate the sample size for a full RCT. Preliminary outcomes were encouraging, with reductions in depression (d = 0.27 CI-0.49 to -0.04, p = 0.021) and anxiety (d = 0.25, CI-0.46 to -0.04, p = 0.018) at follow-up. CONCLUSIONS Results support the feasibility of a school-based, self-referral intervention with older adolescents in a definitive future full-scale trial (Trial no. ISRCTN88636606).
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28
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Sansom‐Daly UM, Wakefield CE, Bryant RA, Patterson P, Anazodo A, Butow P, Sawyer SM, McGill BC, Evans HE, Cohn RJ. Feasibility, acceptability, and safety of the Recapture Life videoconferencing intervention for adolescent and young adult cancer survivors. Psychooncology 2018; 28:284-292. [DOI: 10.1002/pon.4938] [Citation(s) in RCA: 37] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2018] [Revised: 10/05/2018] [Accepted: 11/04/2018] [Indexed: 12/28/2022]
Affiliation(s)
- Ursula M. Sansom‐Daly
- School of Women's and Children's HealthUNSW Sydney Sydney Australia
- Behavioural Sciences Unit, Kids Cancer CentreSydney Children's Hospital Sydney Australia
- Nelune Comprehensive Cancer CentrePrince of Wales Hospital Sydney Australia
| | - Claire E. Wakefield
- School of Women's and Children's HealthUNSW Sydney Sydney Australia
- Behavioural Sciences Unit, Kids Cancer CentreSydney Children's Hospital Sydney Australia
| | | | - Pandora Patterson
- Research, Evaluation and Social Policy UnitCanTeen Newtown Australia
- Cancer Nursing Research Unit, Sydney Nursing SchoolThe University of Sydney Sydney Australia
| | - Antoinette Anazodo
- Behavioural Sciences Unit, Kids Cancer CentreSydney Children's Hospital Sydney Australia
- Nelune Comprehensive Cancer CentrePrince of Wales Hospital Sydney Australia
| | - Phyllis Butow
- Centre for Medical Psychology and Evidence‐based Decision‐making (CeMPED), School of PsychologyUniversity of Sydney Sydney Australia
| | - Susan M. Sawyer
- Department of PaediatricsUniversity of Melbourne Melbourne Australia
- Murdoch Children's Research Institute Melbourne Australia
- Royal Children's Hospital Centre for Adolescent Health Melbourne Australia
| | - Brittany C. McGill
- School of Women's and Children's HealthUNSW Sydney Sydney Australia
- Behavioural Sciences Unit, Kids Cancer CentreSydney Children's Hospital Sydney Australia
| | - Holly E. Evans
- School of Women's and Children's HealthUNSW Sydney Sydney Australia
- Behavioural Sciences Unit, Kids Cancer CentreSydney Children's Hospital Sydney Australia
| | - Richard J. Cohn
- School of Women's and Children's HealthUNSW Sydney Sydney Australia
- Behavioural Sciences Unit, Kids Cancer CentreSydney Children's Hospital Sydney Australia
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