How professionals should communicate with children who have mental healthcare needs

Admissions to paediatric medical wards with a primary mental health diagnosis: a systematic review of the literature

OBJECTIVE

To systematically review the literature describing children and young people (CYP) admissions to paediatric general wards because of primary mental health (MH) reasons, particularly in MH crisis.

DESIGN

PubMed, Embase, PsycINFO, Web of Science and Google Scholar were searched, with no restriction on country or language. We addressed five search questions to inform: trends and/or the number of admissions, the risk factors for adverse care, the experiences of CYP, families/carers and healthcare professionals (HCPs) and the evidence of interventions aimed at improving the care during admissions.Two reviewers independently assessed the relevance of abstracts identified, extracted data and undertook quality assessment. This review was registered with PROSPERO (CRD42022350655).

RESULTS

Thirty-two studies met the inclusion criteria. Eighteen addressed trends and/or numbers/proportions of admissions, 12 provided data about the views/experiences of HCPs, two provided data about CYP's experiences and four explored improving care. We were unable to identify studies examining risk factors for harm during admissions, but studies did report the length of stay in general paediatric/adult settings while waiting for specialised care, which could be considered a risk factor while caring for this group.

CONCLUSIONS

MH admissions to children's wards are a long-standing issue and are increasing. CYP will continue to need to be admitted in crisis, with paediatric wards a common location while waiting for assessment. For services to be delivered effectively and for CYP and their families/carers to feel supported and HCPs to feel confident, we need to facilitate more integrated physical and MH pathways of care.

PROSPERO REGISTRATION NUMBER

CRD42022350655.

Mental Health Admissions to Paediatric Wards Study (MAPS): protocol of a prospective study of mental health admissions to paediatric wards in England using surveillance and qualitative methods

INTRODUCTION

Children and young people (CYP) presenting with a mental health (MH) crisis are frequently admitted to general acute paediatric wards as a place of safety. Prior to the pandemic, a survey in England showed that CYP occupied 6% of general paediatric inpatient beds due to an MH crisis, and there have been longstanding concerns about the quality of care to support these patients in this setting. MAPS aims to generate a Theory of Change (ToC) model to improve the quality of care for CYP admitted to acute paediatric services after presenting with an MH crisis. Here, we describe work packages (WPs) 2 and 3 of the study, which have been granted ethics approval.

METHODS AND ANALYSIS

We will undertake a national (England), sequential, mixed-methods study to inform a ToC framework alongside a stakeholder group consisting of patients, families/carers and healthcare professionals (HCPs). Our study consists of four WPs undertaken over 30 months. WP2 is limited to working with stakeholders to develop a data collection instrument and then use this in a prospective study of MH admissions over 6 months in 15 purposively recruited acute paediatric wards across England. WP3 consists of gathering the views of CYP, their families/carers and HCPs during admissions using semistructured interviews.

ETHICS AND DISSEMINATION

WP2 and WP3 received ethical approval (ref: 23/LO/0349). We will publish the overall synthesis of data and the final ToC to improve care of CYP with MH crisis admitted to general acute paediatric settings. As co-producers of the ToC, we will work with our stakeholder group to ensure wide dissemination of findings. Potential impacts will be upon service development, new models of care, training and workforce planning.

PROSPERO REGISTRATION NUMBER

CRD42022350655.

Preparing children's nurses for working with children and adolescents who self-harm: Evaluating the 'our care through our eyes' e-learning training package

Rates of self-harm among children and adolescents have risen significantly over the past decade and clinical guidelines place children's nurses at the heart of their care. This article reports on the evaluation of 'Our Care Through Our Eyes', an online self-harm learning programme for children's nurses. A self-selected, convenience sample of registered children's nurses (n = 42) completed scales pre- and postlearning programme that captured their attitudes, beliefs, empathy, anxiety, and confidence. Mean change scores were assessed, and qualitative comments captured postintervention were thematically summarized. There were small improvements in participants' attitudes, empathy and confidence were reported. Anxiety scores increased in a small number of items. Qualitative comments confirmed the value of the online learning programme for improving children's nurses' knowledge and understanding of self-harm among CYP. Our findings demonstrate that children's nurses agree on the importance of mental health training in self harm, and this could be a catalyst for renewal of both pre- and postregistration education including support structures within the National Health Service. This study is the first to explore the feasibility of evaluating 'Our Care Through Our Eyes' delivered using e-leaning and could be used to inform further investigations.

A systematic review into healthcare professionals' attitudes towards self-harm in children and young people and its impact on care provision

Self-harming behaviours in children and young people are an alarming reality, with provision of effective treatment historically compromised. The present systematic literature review highlights attitudes displayed by healthcare professionals towards this health problem, providing valuable insight by analysing how these attitudes can impact patient care. Ten studies were included, allowing creation of a narrative synthesis of qualitative, quantitative and mixed-methods evidence. Six themes emerged: negativity, positivity, worry or fear, the emotional impact of working with these patients, professional roles and ward-dependent concerns. Overall, professional negativity towards this patient group, in the form of apprehensiveness, was accentuated by fear of worsening their symptoms. The attitude aforementioned impacts on treatment by hindering creation of meaningful therapeutic relationships. Educational opportunities that increase healthcare professionals' knowledge of self-harm have the potential to provide invaluable power by promoting positive attitudes.

Communicating about Mental Health with Youth and Their Families: A Scoping Review of Best Practices and Implications for Youth with Disabilities

Minimal attention has been placed on supporting the mental health needs of youth with disabilities. Due to a dearth of research on best practices in mental health communication with youth with disabilities, the aim of the scoping review was to identify existing peer-reviewed evidence regarding mental health communication for the general youth population in clinical settings. Three electronic databases were searched. Inclusion criteria were: 1) published in English between 2009 and 2019; 2) children and youth and/or their parents/caregivers; 3) addressed communication-based mental health practices; 4) based in pediatric health care settings. Seven articles were included. Promoting autonomy and engagement, building collaboration and trust, and supplementing conversations with alternative communication approaches were identified as important for having mental health conversations. While implications can be drawn, more work is needed for clinicians to have a rigorous evidence base to draw upon when having these conversations with youth with disabilities.

Enhancing the care of children and young people with mental health issues

Early intervention in children and young people with mental health issues is important to ensure that these issues do not persist into adulthood. However, while children and young people with mental health issues have traditionally been cared for in specialist facilities to ensure their safety, a lack of inpatient beds means that these patients are being admitted to children's wards in general hospitals. Children's nurses require education and training in mental health to provide optimal care for these children and young people. This article explains how the development of evidence-based clinical practice guidelines for children and young people with mental health issues could increase patient safety. Similarly, postgraduate mental health education and training for children's nurses could support enhanced care. The article also discusses how the Nursing and Midwifery Council's revised proficiency standards will require nursing students and registered nurses to enhance their knowledge of caring for people with mental health issues.