Effects of climate change on the health of children and young people

The effects of climate change, such as air pollution and extreme heat events, can adversely affect the physical and mental health of children and young people at all ages. This article explores the effects of climate change on children and young people's development and explains the effects of air pollution and heatwaves on their health. The article also discusses how children and young people are knowledgeable and concerned about the effects of climate change and can offer new perspectives on addressing these effects. Finally, the authors consider the role of nurses in raising awareness of the adverse effects of climate change on children's health, incorporating climate change in their practice and promoting opportunities for children's involvement in healthcare decision-making, strategies and policy development.

Consequences of the Coronavirus disease 2019 pandemic on child and adolescent mental, psychosocial, and physical health: A scoping review and interactive evidence map

Effects of the Coronavirus disease 2019 (COVID-19) pandemic on children stem beyond immediate infectious and post-infectious risks. Our aim was to conduct a scoping review and produce an online Interactive Evidence Map (IEM) highlighting available literature around unintended effects of the pandemic on children's and adolescents' mental, psychosocial, and physical health. A search was run monthly in MEDLINE, PsycINFO, CENTRAL, and Cochrane COVID-19 Study Register from May 1st 2021 through April 30th 2022. All articles involving children and adolescents under 18 years of age relating to any unintended mental, psychosocial, and physical health consequences of the pandemic and resultant restrictions were included. Data were extracted and topics categorized, with corresponding data uploaded into EPPI-Reviewer and transferred to EPPI-Mapper for visualization. A total of 14,555 citations were screened and 826 (6%) articles included. Most articles reported on mental health outcomes, particularly anxiety (n = 309, 37%) and depression (n = 294, 36%). Psychosocial outcomes related to lockdowns such as loneliness (n = 120, 15%) and impact on adolescent relationships with others (n = 149, 18%) were also reported. Fewer articles examined physical consequences, but those that did mostly focused on child abuse (n = 73, 9%). Overall, currently mapped literature focuses on consequences related to mental health outcomes such as anxiety and depression.

Developing a web-based app for non-mental health nurses to assess the mental health needs and risks of children and young people

There is high demand for specialist mental health services for children and young people in the UK. Non-mental health nurses are well-placed to assess the mental health needs and risks of children and young people to maximise opportunities for early intervention and relieve the pressure on child and adolescent mental health services. This article provides an overview of a service development project to develop a web-based application (app) to support non-mental health nurses when assessing the mental health needs and risks of children and young people. The article describes the development, testing and evaluation process, which involved consultation with children and young people as well as interviews, focus groups and an online survey with a range of professionals working with children and young people. Overall, the findings suggest that the app is appropriate for use by non-mental health nurses in terms of quality, functionality and acceptability.

A postgraduate training programme in child and adolescent mental health in a lower-middle-income country: a partnership model from Nigeria

This paper describes a postgraduate training programme in child and adolescent mental health (CAMH) in Nigeria. It explains the background, curriculum development, teaching, evaluation and outcomes. By its 10th year the programme had trained 166 CAMH professionals from 14 African countries. Many of the graduates are running clinical CAMH services in their countries, mostly pioneered by them. They are also conducting CAMH training, including as faculty on the programme, and some are in international CAMH leadership roles. Key success elements of the programme that can be replicated in other low- and middle-income countries include international partnership, adopting a train-the-trainer approach, using a curriculum that covers clinical aspects of CAMH while also developing leadership and research skills, use of free-access training resources, and access to seed funding.

Psychiatry trainee experience of working in a child and adolescent eating disorder program

OBJECTIVES

Eating disorders are serious psychiatric conditions that affect people of all ages. Many psychiatry trainees' first and only experience with eating disorders during training is their Child and Adolescent Psychiatry (CAP) rotation. This study aimed to explore the learning experience of psychiatry trainees working within an Eating Disorder Program (EDP) during their CAP rotation.

METHODS

Fifteen trainees who participated in the EDP were recruited to complete an online survey and focus groups; a thematic analysis design was used to identify themes emerging from their responses.

RESULTS

Themes emerged from the trainee learning experience of working in the EDP around what they found they learnt, what aided that process, what was difficult, and recommendations for future improvement.

CONCLUSIONS

This study provided insight into the trainee experience in an EDP as one example of how trainees can learn about eating disorders and one way that could inform future workforce and training initiatives.

Stress and loneliness: exploring adolescents' use of social media as a coping strategy during COVID-19

BACKGROUND

During the coronavirus disease 2019 (COVID-19) pandemic, adolescents used various coping strategies to manage stress and loneliness. One such strategy was to engage in active coping, social relations coping and humour coping via social media. Such coping strategies can be helpful but can also reinforce stress and loneliness.

AIM

To explore adolescents' use of social media to manage stress and loneliness at a time of restricted social contacts due to the COVID-19 pandemic, including potential differences between adolescents according to gender, age, area of residence and extent of social media use.

METHOD

A cross-sectional design and an online questionnaire were used to survey a convenience sample of adolescents aged between 12 and 18 years in Jordan. Three data collection tools were used - the modified Brief Coping Scale, the six-item Revised UCLA Loneliness Scale and the Perceived Stress Scale.

RESULTS

A total of 770 adolescents participated, half of whom were using social media more than before the pandemic. Increased use of active coping, social relations coping and humour coping was associated with decreases in stress and loneliness. Active coping contributed the most to reducing levels of stress while social relations coping contributed the most to reducing levels of loneliness. Younger participants made more use of active coping and humour coping than older participants.

CONCLUSION

Social media use can be a positive coping strategy for adolescents to manage stress and loneliness during a crisis such as the COVID-19 pandemic.

Adolescent Depression Prevalence and Factors: A Jordanian Cross-Sectional Study

Objective There is a great deal of variation in the prevalence of adolescent depression among nations, but overall, it is a severe and common mental illness that is a major contributor to disability on a global scale. This study aimed to determine the prevalence of depression, the severity of its symptoms, and its characteristics among adolescents residing in Amman, Jordan, in 2023. Method A cross-sectional design was used to collect descriptive data from 784 adolescents from Jordan, aged between 14 and 17 years. Participants were administered the Patient Health Questionnaire-9 to assess the prevalence and severity of depression as well as measures of socio-demographics and health history. Significance was set at p ≤.05. Results The mean age was 15.56 +/- 1.077 with 55% female and 45% male participants, with a prevalence of moderate to severe depression of 32.4%. This study identified four significant predictors of depression: female sex, cigarette smoking, history of mental health problems, and family history of psychiatric disorders. Conclusion Our findings highlight the importance of directing prevention and intervention efforts toward adolescents, considering the projected increase in depression rates across the Arab region. This serves as a warning for policymakers and healthcare professionals to prioritize this demographic in their strategies.

Early Risk Factors for Self-Injurious Thoughts and Behaviours: A UK Population-Based Study of 219,581 People

Mental disorders are a major problem among young people. To identify early risk factors of self-injurious thoughts and behaviours (SITB) among young adults with mental health problems, this case-control study drew data from the Clinical Practice Research Datalink (CPRD), a primary care database covering 8% of the UK population. We explored the role of early factors (presenting at 8-14 years old) for suicidal ideation, suicide attempts, and non-suicidal self-injury (NSSI) in young adulthood (age 18-25 years) by performing logistic regressions. Our sample consisted of 219,581 participants, of which 6.51% had at least one SITB in young adulthood. Early risk factors for SITB included early NSSI, suicidal ideation, sexual abuse, behavioural problems, and mood and psychotic symptoms. Frequency of GP visits had a protective effect. Lack of access to mortality data, ethnicity, and socioeconomic status was a limitation of the current study. In conclusion, early symptoms in late childhood/early adolescence can be the start of long-standing problems going into adult life. The training of primary care providers in suicide risk assessment and proper co-ordination with child and adolescent mental health services are crucial for suicide prevention.

Sleep disturbance and suicidality in psychiatrically hospitalized adolescents: The role of specific emotion regulation domains

BACKGROUND

Sleep disturbance is associated with broadband measurements of emotion regulation (ER). The linkage between ER, a multidimensional process, and suicidal ideation and suicide attempt is also documented in theoretical and empirical work. Recent research indicates that distinct profiles of ER are associated with psychiatric outcomes, including adolescent suicidal ideation and attempt. The present study examined whether specific domains of ER would explain the association between sleep disturbance, and ideation and attempt among psychiatrically hospitalized adolescents.

METHOD

The sample included 284 adolescents who completed self-report measures on sleep disturbance, ER, suicidal ideation, suicide attempt, and psychiatric symptoms upon inpatient hospitalization.

RESULTS

Findings indicated that sleep disturbance was associated with suicidal ideation. Further, a single ER domain (perceived limited access to ER strategies) fully accounted for the significant association between sleep disturbance and suicidal ideation. A reported suicide attempt in the past week was correlated with the nonacceptance of emotional responses, perceived limited access to ER strategies, and emotional clarity, but was not associated with sleep disturbance.

DISCUSSION

The current findings highlight the importance of examining narrowband ER and indicate the presence of differential associations between sleep disturbance, ER, and suicide-related outcomes. Findings further elucidate the possible role of impaired cognitive responses to emotional experiences in the co-occurrence of sleep disturbance and youth psychiatric outcomes.

Assessing Outcomes for Cost-Utility Analysis in Children and Adolescents With Mental Health Problems: Are Multiattribute Utility Instruments Fit for Purpose?

OBJECTIVES

The objective of this study was to compare the concurrent and construct validity, as well as the sensitivity of 5 multiattribute utility instruments (MAUIs), including the Assessment of Quality of Life-6D (AQoL-6D), EQ-5D-Y, Health Utilities Index (HUI)-2 and HUI-3, and the Child Health Utility 9D, 1 generic pediatric quality of life instrument, with 3 routinely collected outcome measures in Australian mental health services (Strengths and Difficulties Questionnaire, Clinical Global Assessment Scale [CGAS] and the Health of the Nation Outcome Scale for Children and Adolescents) in children and adolescents diagnosed of internalizing (eg, anxiety/depression), externalizing (eg, attention deficit hyperactivity disorder/conduct disorders), and trauma/stress related mental disorders.

METHODS

A cross-sectional survey of measures, including demographic and basic treatment information, in children/adolescents recruited via 5 child and youth mental health services in Queensland and Victoria, Australia. Measures were either proxy or self-report completed, the CGAS and the Health of the Nation Outcome Scale for Children and Adolescents were clinician completed.

RESULTS

The sample included 426 participants and had a mean age of 13.7 years (range 7-18 years). Utilities (as calculated from MAUIs) were generally lower in older adolescents and those with internalizing disorders. All MAUIs and self-reported clinical measures significantly correlated with each other (absolute correlation range 0.40-0.90), with the AQoL-6D showing generally higher levels of correlations. Correlations between the MAUIs and clinician/proxy-reported measures were weak, regardless of diagnosis (absolute correlation range 0.09-0.47). Generally, EQ-5D-Y, HUI-2, and AQoL-6D were more sensitive than Child Health Utility 9D and HUI-3 when distinguishing between different severities according to clinician-assessed CGAS (effect size range 0.17-0.84).

CONCLUSIONS

The study showed that the commonly used MAUIs had good concurrent and construct validity compared with routinely used self-complete measures but poor validity when compared with clinician/proxy-completed measures. These findings generally held across different diagnoses.

Social difficulties in adolescent attention deficit hyperactivity disorder: Social motivation, social anxiety and symptom severity as contributing factors

BACKGROUND

Many interventions have been developed to address the social difficulties commonly experienced by adolescents with attention-deficit/hyperactivity disorder (ADHD), yet they are largely ineffective.

OBJECTIVE

This study examined social impairment among adolescents with and without ADHD, determining whether gender, social anxiety, age, and ADHD symptom type (inattention and hyperactivity/impulsivity) and severity are associated with social impairment.

METHOD

Parents and primary caregivers of adolescents (aged 13-17) with (n = 76) and without ADHD (n = 36) completed the Strengths and Weaknesses of ADHD and Normal Behavior, Social Responsiveness Scale 2nd Edition, and Spence Children's Anxiety Scale.

RESULTS

Adolescents with ADHD scored significantly higher than TD adolescents across social impairment domains. ADHD symptoms were associated with severity of impairment in all domains excluding Social Motivation. Hyperactivity/impulsivity and social anxiety predicted social impairment, whereas gender did not.

CONCLUSION

Adolescents with ADHD are more likely to experience social impairment than TD adolescents, and interventions targeting symptom reduction and social anxiety may improve these social impairments.

Nasogastric tube feeding under restraint: practical guidance for children's nurses

The number of children and young people admitted to children's wards with an eating disorder has increased significantly since the start of the coronavirus disease 2019 (COVID-19) pandemic. In the most extreme cases, those with severe malnutrition may need to be fed via a nasogastric tube without their consent. Children's nurses working on hospital wards may therefore care for children and young people who need to receive nasogastric tube feeding under physical restraint. This article offers an overview of eating disorders and their detrimental effects as well as practical advice for children's nurses, supporting them to provide safe, compassionate and person-centred care to their patients.

The predictive validity of the family risk survey and child risk survey for identifying persistent firesetting risk

Young firesetter behavior poses significant risks to individuals and communities. Intervention is important to mitigate youth firesetting, and treatment needs vary depending on underlying motives. Effective screening of persistent firesetter risk to inform intervention approach is critical to ensure appropriate matching of risk and needs. This study aimed to evaluate the utility of the child risk survey (CRS) and family risk survey (FRS) for predicting persistent firesetting risk, and subsequent triaging of cases toward the appropriate treatment. A total of 61 families engaged with the Firelighting Consequences Awareness Program, Melbourne, Australia, completed the CRS and FRS preintervention, and reported their firesetting behavior 1-year postintervention. The CRS was not effective for correctly predicting persistent and nonpersistent firesetters. The FRS was successful at predicting persistent firesetters 85% of the time, but had a high rate of false positives, overclassifying nonpersistent firesetters as high risk. Finally, the actual rate of firesetters that would be deemed suitable for each of the three recommended interventions based on the CRS and FRS scoring protocols was substantially different to the expected rates described in the accompanying manual. Implications for service provision are discussed.

Receiving thank you letters in inpatient child and adolescent mental health services (CAMHS): A qualitative study of nurse's experiences

INTRODUCTION

Previous research has found that nurses in inpatient CAMHS can struggle to define their role and contribution to patient care. While gratitude has received increased attention in relation to subjective well-being in healthcare settings, the receipt of gratitude in the form of thank you letters is currently unexplored in the CAMHS context.

AIM/QUESTION

To gain an understanding of how inpatient CAMHS nursing staff experience receiving expressions of gratitude from patients.

METHOD

Adopting an exploratory qualitative approach, two focus group interviews were conducted. Participants completed a brief online follow-up questionnaire. Data were examined using thematic analysis.

RESULTS

Reflecting on expressions of gratitude improved understanding of professional identity, enhanced reflexivity, enhanced team cohesion and increased professional and personal confidence and motivation.

DISCUSSION

Expressions of gratitude appear to offer meaningful sources of feedback for nurses and support a greater sense of personal accomplishment, professional role and the relational impact of care for patients. When nurses share and discuss expressions of gratitude with colleagues this brings benefits additional to the initial receipt.

IMPLICATIONS FOR MENTAL HEALTH NURSING

Nurses should be supported to engage in discussing and reflecting upon receiving thank you letters and other tokens of gratitude although care should be taken to support those who might experience unease or increased self-doubt.

Central precocious puberty: assessment, diagnosis and decisions about treatment

Precocious puberty is defined as the onset of puberty before the age of eight years in girls and before the age of nine years in boys. It is associated with negative physical health consequences in the long term and can also have negative psychosocial effects, particularly in adolescence. Central precocious puberty (CPP), which is caused by the early activation of the hypothalamic-pituitary-gonadal axis, is the more prevalent form of precocious puberty. This article explains CPP and its signs, assessment, diagnosis and treatment. It also discusses the factors to consider when deciding whether or not to treat it, stressing the importance of a shared decision-making process that children and parents should be involved in. Precocious puberty must be diagnosed and managed by specialists, but all children's nurses need a broad understanding of the condition so that they can refer children as early as possible and reassure and advise families.

Promoting young people's mental health: the role of community nurses

There are growing concerns about the mental health and well-being of young people, including how these have been negatively affected by factors such as the coronavirus disease 2019 (COVID-19) pandemic and social media. Community nurses are in an ideal position to promote positive mental health and ensure timely referral to appropriate services to enable young people to access the support they need. This article explores how the pandemic and social media have affected young people's mental health, particularly in relation to anxiety. It also explains how nurses can discuss these issues with young people and their parents or guardians.

Reformed child and adolescent mental health services in a devolved healthcare system: a mixed-methods case study of an implementation site

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.

Repairing attachment in families with depressed adolescents: A task analysis

AIMS

This exploratory pilot study (N = 3 sessions, 793 speech units) used task analysis to refine an early model of the attachment task in attachment-based family therapy (ABFT). The attachment task aims to repair long-standing parent-adolescent relational ruptures that inhibit parents from being a resource for adolescents recovering from depression and/or suicidality.

METHODS

Video recordings of three attachment task sessions with strong adherence to the model were selected for intensive study. Two sessions were rated as successful (i.e., attachment was repaired) and one as unsuccessful (i.e., attachment repair did not occur). Sessions were then coded using Structural Analysis of Social Behavior (SASB).

RESULTS

The current SASB analysis provided empirical support for our previous clinical impression that the task involves three parts: (I) adolescent disclosure of attachment rupture, (II) parent disclosure, and (III) a more mutual conversation. SASB also provided insights into more subtle elements of the model.

CONCLUSION

Successful attachment sessions were associated with high parent affiliation and autonomy-both while affirming the adolescent's story and when disclosing their own experience. Unsuccessful task attempts were associated with parental enmeshment and hostile belittling, blaming, and distancing. An enhanced model of ideal parent behaviors during the attachment task is offered, including space for parent disclosure-perhaps even apology-that is both warm and independent, leading to a more mutual parent-adolescent conversation. Clinically, the findings support the importance of the therapist focusing on the process and quality of parent-child interactions to facilitate attachment repair.

Internet-based interventions to support recovery in youth: A systematic review

Personal recovery represents a paradigm shift in how individuals are seen to benefit from mental health interventions, from a narrow view of symptom reduction to a holistic, multi-dimensional view of well-being, functional gains and rehabilitation. Although there is a large body of evidence supporting the use of recovery-oriented care in adults, research on personal recovery amongst youth with mental health concerns is an emerging area of research. Efforts to promote youth mental health have also focussed on the use of digital applications and platforms as a means of overcoming barriers related to factors including stigma and lack of available services. This systematic review aims to review the literature on existing internet-based, youth mental health interventions with regard to (a) identifying elements of the programs that align with the personal recovery and (b) outcome measures utilised in assessing personal recovery. Eleven papers were identified that met the inclusion criteria. Five of the programs reviewed from these eleven papers showed efficacy for recovery processes. The results offer preliminary support and guidance for the use of internet-based mental health interventions in the promotion of personal recovery amongst youth. Future research and practice are suggested to further develop understanding in this area.

Enhancing primary care psychology services with assistant psychologists in Ireland: An evaluation of output, throughput and stakeholder satisfaction

Primary care mental health services need to expand to assist the increased number of people reporting mild to moderate mental health difficulties. In Ireland, the primary care mental health service has been recently enhanced through the employment of Assistant Psychologists (AP) in primary care psychology. This paper provides an early and brief evaluation of the impact of the AP-enhanced model through a tripartite approach to evaluation which utilises measures of throughput, output and stakeholder satisfaction. We use data from two sources; Health service key performance indicators, and a routinely gathered minimal dataset of client measures. Results indicate that the numbers of clients seen in the period rose by 16%, that AP-delivered treatments are beneficial for clients with mild to moderate mental health difficulties, and more than 80% of clients reported being 'totally satisfied' with the care received. The data provide early evidence that the AP model is beneficial in meeting clients' needs across a range of presentations within the service admission criteria, and that the AP-enhanced model may offer a satisfactory solution to primary care needs. However, further data collection is required, and additional stakeholder input is necessary for a complete evaluation of the assistant psychologist model in primary care.

Hopelessness during and after the COVID-19 pandemic lockdown among Chinese college students: A longitudinal network analysis

INTRODUCTION

In China, recurrent pandemics require frequent city-wide lockdowns and quarantine actions to contain the impact of COVID-19, exposing college students to psychological problems, including hopelessness. Hence, the purpose of helping problematic college students alleviate hopelessness symptoms motivates us to carry out the present study to explore their interrelationship.

METHODS

Hopelessness (i.e., a complex phenomenon with important clinical consequences, such as depression and suicidality) was investigated in a large longitudinal sample of college students (N = 2787; 58.59% female; age _{mean ± SD}  = 18.34 ± 0.92) who were recruited during and after the COVID-19 lockdown using the Beck Hopelessness Scale (BHS).

RESULTS

Applying the novel approach (i.e., symptom network analysis), the results indicated that the edge of #BHS1 (i.e., [NOT] hope-enthusiasm)-#BHS15 (i.e., [NOT] faith-in-the-future) showed the strongest association both in Wave 1 and Wave 2. Similarly, #BHS20 (i.e., not-trying) had the highest node expectedinfluence (centrality) in the hopelessness symptoms network both among Wave 1 and Wave 2. The Network Comparison Test indicated that the global network strength significantly differed between the two time points. As expected, college students' hopelessness will gradually dissipate with the end of segregation control. The stability and accuracy indicated that the network analysis results were trustworthy.

CONCLUSIONS

The study findings provide evidence that central nodes and edges connecting symptoms should be addressed. Further interventions and treatments that may target these symptoms are essential to effectively alleviate the overall hopelessness level among college students. Theoretical and clinical potential consequences were discussed in detail.

COVID-19-related school closures and patterns of hospital admissions with stress-related presentations in secondary school-aged adolescents: weekly time series

This study examines health service indicators of stress-related presentations (relating to pain, mental illness, psychosomatic symptoms and self-harm) in adolescents of secondary school age, using Hospital Episode Statistics data for England. We examined weekly time series data for three academic years spanning the time before (2018-2019) and during the COVID-19 pandemic (2019-2020 and 2020-2021), including the first lockdown when schools were closed to the majority of pupils. For all secondary school children, weekly stress presentations dropped following school closures. However, patterns of elevated stress during school terms re-established after reopening, with girls aged 11-15 showing an overall increase compared with pre-pandemic rates.

Supporting children's nurses to deliver trauma-informed care

World events, such as the conflict in Ukraine, the humanitarian crisis in Afghanistan and the coronavirus disease 2019 pandemic, have highlighted the effects of trauma and adverse childhood experiences on children and young people. Adverse childhood experiences can lead to suboptimal health and risk-taking behaviours during adolescence and adulthood, while multiple adverse childhood experiences can manifest as complex trauma, toxic stress, anxiety or depression across a person's lifespan. This article discusses adverse childhood experiences and the concept of trauma-informed care, which involves recognising and understanding the negative events that have affected a person and how these relate to suboptimal health. The author suggests that developing resilience and using self-care strategies can support nurses to adopt a trauma-informed approach to care. This can assist them to recognise, understand and reflect on the effects of adverse childhood experiences in themselves as well as in their patients. The author also outlines a hybrid approach to debrief that can support staff to manage stressful situations and challenging workplace experiences.

Single session family therapy for beginners: what difference does it make to psychiatry registrars to participate in family sessions in front of and behind the screen?

OBJECTIVE

Current competencies required for fellowship of the RANZCP require psychiatry registrars to have experience in working with clients across all age groups, as well as working with families and the client's wider network, however gaining this experience is not always easy for trainees. This paper reports on the experience of participating in Single Session Family Therapy (SSFT) during registrar training as a different modality for learning.

METHOD

An online survey was conducted with fourteen registrars who had participated in SSFT during their child and adolescent rotation. Qualitative and simple quantitative data were collected and analysed.

RESULTS

Participating in SSFT during training was initially daunting, but had a positive effect on trainees, including influencing some towards focussing their future sub-specialisation in the child and youth area. Experience came through learning by doing, and seeing change. Registrars learnt about: understanding the role of the family; teamwork; technical skills; and gained confidence.

CONCLUSIONS

Opportunities for trainees to participate in SSFT enables powerful learning beyond what can be taught in the classroom. Such opportunities may enhance registrars' perceptions of family work, and may positively influence decision about future sub-specialisation.

A novel application of the Lego® Serious Play® methodology in mental health research: Understanding service users' experiences of the 0-19 mental health model in the United Kingdom

AIM

The 0-19 model is an example of a service that has been retransformed in line with UK's recent policies. However, there is limited qualitative research exploring young people's experiences with the accessibility and acceptability of retransformed models through more participatory qualitative approaches. This study aimed to understand service users' experiences of accessibility and acceptability with the 0-19 model and its service provision. In addition, we also aim to outline the process and application of the Lego® Serious Play® methodology to the context of children and young people's mental health research and reflect on the usefulness of this novel approach and its potential for further research use.

METHODS

A qualitative methodology based on the Lego® Serious Play® approach was used to investigate service users' perceptions of the accessibility and acceptability of the 0-19 model. This novel approach is viewed as a facilitator of engagement, which also stimulates critical thinking and reflective practice. All interviews were thematically analysed.

RESULTS

Seven participants constructed 14 models and provided metaphorical narratives for them besides engaging in group discussions. Thematic analysis of the participants' models and narratives resulted in six identified themes: accessibility, doors into the unknown, let it out, overcoming obstacles, less is sometimes better and satisfaction with the 0-19 model and its provision.

CONCLUSION

Participants in this study perceived the 0-19 model as acceptable and, to a degree, accessible. Participants identified a range of barriers to accessibility, such as inconvenient locations, long waiting and inflexible working times.

A comparison of child and adolescent psychiatry in the Far East, the Middle East, and Southeast Europe

INTRODUCTION

Despite the high proportion of children and adolescents living in low- and middle-income countries, 95% of all specialized child and adolescent mental health resources are located in high-income countries. To strengthen child and adolescent mental health services (CAMHS), first it is necessary to complete an assessment of the available services and training programs to determine what is needed, particularly in regions with young populations, such as Southeast Europe, the Far East, and the Middle East. The aim of this article is to compare the status of child and adolescent psychiatry (CAP) training programs and the workforce in CAMHS in three geographical regions, to identify similar problems, highlight success stories, and to make recommendations for future studies.

METHODS

This study compared CAP training programs and CAMHS workforce using the World Psychiatric Association, CAP Section's regional studies data.

RESULTS

This study included data from 44 countries: 18 countries in the Far East, 15 countries in the Middle East, and 11 countries in Southeast Europe. There were significant differences both within, and between, the three included regions with regards to availability and infrastructure of CAP training programs. Besides Greece, all included countries reported the need for more child and adolescent psychiatrists and allied child and adolescent mental health professionals.

DISCUSSION

There is an urgent need for more qualified child and adolescent psychiatrists and allied professionals in a very large group of countries in three different geographic regions with great differences in religion, culture, and economy.

The all-Wales forensic adolescent consultation and treatment service (FACTS): A 5-year referral cohort study

BACKGROUND

FACTS is a Wales-wide mental health service for 10-17-year-olds with needs beyond the remit of mainstream child and adolescent mental health services (CAMHS). As a purely consultation-liaison service, it differs from other UK services in the field.

AIMS

To describe a complete cohort of referrals to FACTS 2013-2017 with service exit by June 2018.

METHODS

Clinical, social and offending data were extracted from FACTS records.

RESULTS

80 young people completed a FACTS episode, averaging nearly a year (309 days; range 13-859 days). Mostly boys (65, 81%) of mean age 15.4 years (range 9-18), two-thirds (n = 53) had three or more referral reasons, one invariably being threatened/actual harm to others; only half were criminal-justice involved. Half (41, 51%) were committing sexually harmful acts. Half were self-harming (41, 51%). All but seven had had at least one adverse childhood experience (ACE), nearly half (35, 44%) four or more. Nevertheless, post-traumatic stress disorder (PTSD) was rarely diagnosed (7, 9%); just over one-quarter (23, 29%) had no diagnosis at all. Correspondence analyses endorsed two distinct Attention deficit hyperactivity disorder groups, distinguished by presence/absence of evidenced brain damage or dysfunction. Suicide-related behaviours clustered with the other diagnoses, flashbacks and psychotic symptoms with no diagnosis. Change in home circumstances during a FACTS episode was slight.

CONCLUSIONS

The complexity of presenting problems and service involvement evidences need for FACTS. The extent of persistently harmful sexual behaviours is a novel finding, suggesting need for more expert input for this at other service levels. Rarity of PTSD diagnoses was surprising given the extent of ACEs. This raises concerns that services focus on disorder signs rather than the child's inner life. Given the extent of problems, minimal change may be a positive outcome - especially when remaining in the community. Further development of this service should include explicit case-by-case goals and indicative outcome markers.

Bringing Parent-Child Interaction Therapy to South Africa: Barriers and Facilitators and Overall Feasibility-First Steps to Implementation

There is a large assessment and treatment gap in child and adolescent mental health services, prominently so in low- and middle-income countries, where 90% of the world's children live. There is an urgent need to find evidence-based interventions that can be implemented successfully in these low-resource contexts. This pre-pilot study aimed to explore the barriers and facilitators to implementation as well as overall feasibility of Parent-Child Interaction Therapy (PCIT) in South Africa. A reflective and consensus building workshop was used to gather South African PCIT therapist (N = 4) perspectives on barriers, facilitators, and next steps to implementation in that country. Caregiver participants (N = 7) receiving the intervention in South Africa for the first time were also recruited to gather information on overall feasibility. Facilitators for implementation, including its strong evidence base, manualisation, and training model were described. Barriers relating to sustainability and scalability were highlighted. Largely positive views on acceptability from caregiver participants also indicated the promise of PCIT as an intervention in South Africa. Pilot data on the efficacy of the treatment for participating families are a next step. These initial results are positive, though research on how implementation factors contribute to the longer-term successful dissemination of PCIT in complex, heterogeneous low-resource settings is required.

Process and Outcome Evaluations of Smartphone Apps for Bipolar Disorder: Scoping Review

Background

Mental health apps (MHAs) provide opportunities for accessible, immediate, and innovative approaches to better understand and support the treatment of mental health disorders, especially those with a high burden, such as bipolar disorder (BD). Many MHAs have been developed, but few have had their effectiveness evaluated.

Objective

This systematic scoping review explores current process and outcome measures of MHAs for BD with the aim to provide a comprehensive overview of current research. This will identify the best practice for evaluating MHAs for BD and inform future studies.

Methods

A systematic literature search of the health science databases PsycINFO, MEDLINE, Embase, EBSCO, Scopus, and Web of Science was undertaken up to January 2021 (with no start date) to narratively assess how studies had evaluated MHAs for BD.

Results

Of 4051 original search results, 12 articles were included. These 12 studies included 435 participants, and of these, 343 had BD type I or II. Moreover, 11 of the 12 studies provided the ages (mean 37 years) of the participants. One study did not report age data. The male to female ratio of the 343 participants was 137:206. The most widely employed validated outcome measure was the Young Mania Rating Scale, being used 8 times. The Hamilton Depression Rating Scale-17/Hamilton Depression Rating Scale was used thrice; the Altman Self-Rating Mania Scale, Quick Inventory of Depressive Symptomatology, and Functional Assessment Staging Test were used twice; and the Coping Inventory for Stressful Situations, EuroQoL 5-Dimension Health Questionnaire, Generalized Anxiety Disorder Scale-7, Inventory of Depressive Symptomatology, Mindfulness Attention Awareness Scale, Major Depression Index, Morisky-Green 8-item, Perceived Stress Scale, and World Health Organization Quality of Life-BREF were used once. Self-report measures were captured in 9 different studies, 6 of which used MONARCA. Mood and energy levels were the most commonly used self-report measures, being used 4 times each. Furthermore, 11 of the 12 studies discussed the various confounding factors and barriers to the use of MHAs for BD.

Conclusions

Reported low adherence rates, usability challenges, and privacy concerns act as barriers to the use of MHAs for BD. Moreover, as MHA evaluation is itself developing, guidance for clinicians in how to aid patient choices in mobile health needs to develop. These obstacles could be ameliorated by incorporating co-production and co-design using participatory patient approaches during the development and evaluation stages of MHAs for BD. Further, including qualitative aspects in trials that examine patient experience of both mental ill health and the MHA itself could result in a more patient-friendly fit-for-purpose MHA for BD.

Tourette's syndrome: challenging misconceptions and improving understanding

Tourette's syndrome affects about 1% of the school-age population. Children and young people with the condition exhibit involuntary motor and vocal (also known as phonic) tics. Only 10% of those with Tourette's syndrome have coprolalia, which involves involuntary swearing and inappropriate language. Tourette's syndrome often presents with other conditions such as obsessive-compulsive disorder, autism and attention deficit hyperactivity disorder. Those affected by Tourette's syndrome may be able to manage the condition with little or no professional support, but some may need pharmacological and nonpharmacological input, particularly from mental health services. It is essential that peers, teachers, healthcare staff and members of the public are aware of Tourette's syndrome to ensure that children and young people living with the condition are supported well.

Therapeutic Alliance in Cognitive Behavioural Therapy in Child and Adolescent Mental Health-Current Trends and Future Challenges

This extended literature review proposes to present the trends in the therapeutic alliance, outcomes, and measures in the last decade within the premises of individual cognitive behaviour therapy (CBT) and its innovations, used as an interventional measure in the context of child and adolescent mental health setting. A brief background of the rationale for conducting this literature search is presented at the start. This is followed by the methodology and design which incorporates the inclusion and exclusion criteria and the basis for the same. The critical appraisal of the primary studies is presented in the literature review section with a brief description of the summary features of the studies in the study tables followed by the results and discussion of the study findings. To summarise, the literature review of primary studies conducted in the last decade demonstrates the need for further research to be conducted both in the field of CBT in children and therapeutic alliance, competence, and therapy outcomes, integrating perspectives in child development, carer alliance, and the social construct theory in children, to allow for further innovations in CBT in the context of increasing challenges in the current times of exponentially developing technology and its utility without compromising the quality of therapy. In conclusion, recommendations are made as a guideline for future studies and research in this field.

Enhancing knowledge of mental health issues among children's nursing students: evaluation of a service user-led workshop

BACKGROUND

Over the past 20 years, the number of children and young people with mental health issues has increased. During their clinical placements, children's nursing students often encounter such service users, as well as mothers with mental health issues such as postnatal depression. Many of these students have reported feeling inadequately prepared to meet the needs of these service users.

AIM

To evaluate a service user-led workshop to improve the knowledge and confidence of children's nursing students in caring for children and young people with mental health issues.

METHOD

One university in the south of England ran an interactive workshop as part of a final-year module for BSc and MSc children's nursing students. The workshop was facilitated by service users who had experienced mental health issues. Questionnaires were administered before and after the workshop to collect data from students who attended, then quantitative and qualitative analyses of the data were conducted.

FINDINGS

This study found that children's nursing students gained knowledge and confidence in caring for children and young people with mental health issues after attending the workshop. Four themes were identified from the pre-questionnaire data: fear and anxiety; boundaries; mixed experiences; and learning on the job. The themes of boundaries and learning on the job were identified again in the post-questionnaire data, as well as the additional themes of 'being with, rather than doing' and 'further knowledge'.

CONCLUSION

Service user involvement is an essential aspect of nurse education due to its positive and motivating effects on students. Future research could explore the optimal type of service user input required at different stages of nurse education, to ensure that it enhances the development of students' knowledge and confidence.

Multiaxial classification in child and adolescent mental health - a reaffirmation of benefit and practical applications

OBJECTIVE

Classification systems and their practical implications have become increasingly important in child and adolescent psychiatry. This paper presents the evolution and practical applications of a multiaxial classification system for children and adolescents presenting to mental health services. Included are some worked examples demonstrating both the complexity of many presentations and how broadening the use of the multiaxial system can help in identifying appropriate interventions.

CONCLUSIONS

Classification systems in child and adolescent psychiatry have largely remained uniaxial in nature. A multiaxial system encapsulates the broader biopsychosocial aspects of the presenting child or adolescent, and orders complex data in a concise manner. This approach can be used to concisely communicate with other treating clinicians, and assist with case reviews, formulation and teaching.

Exploring Behavioural Activation as a treatment for low mood within CAMHS: An IPA study of adolescent experiences

Low mood is the most commonly diagnosed mental health condition affecting adolescents; however, it remains complex to treat due to multi-systemic risk and maintaining factors. Behavioural Activation (BA) is a brief therapy which demonstrates promising treatment outcomes, although limited qualitative accounts exist of how adolescents experience this. This is one of the first studies undertaken in Child and Adolescent Mental Health Services (CAMHS) to explore the perspectives of adolescent's with low mood who have received BA therapy. Interpretative phenomenological analysis was conducted from one-to-one interviews with nine adolescents who received BA, generating an idiographic account of their experiences. Three superordinate themes emerged: how the format of BA can promote the integration of coping skills into one's life; how interpersonal connections and therapeutic relationships may improve intervention outcomes; and how BA principles could be internalised as part of a young person's day-to-day life. Participants valued the structure and flexibility of the manualised approach, forming an alliance with the therapist, and enhancing interpersonal relationships. This study details how BA can enhance resiliency skills for adolescents experiencing low mood and illustrates some of the change process at inter and intrapersonal levels, which should guide further youth-led research.

Developmental Understanding of Death and Grief Among Children During COVID-19 Pandemic: Application of Bronfenbrenner's Bioecological Model

COVID-19 Pandemic has influenced death-related attitudes and understanding during the childhood development leading to a life-long impact. Factors like pandemic-related movement restrictions, school closures, and parents' stay-at-home have exposed children to the phenomenon of grief and death. In that case, children anticipate adverse outcomes and fear while they struggle with unanswered questions. Children may not have coping skills needed to manage their grief in constructive ways to identify, normalize, and express their responses to the loss in their lives. Naming and validating these responses as distinctive aspects of grief process and providing safe space to express their feelings are essential components of a child's coping with loss and grief. This is crucial to consider, as different children react to and are influenced by their environments differently. This article aims to explore the developmental understanding of the process of death and grief by applying the conceptual framework of Bronfenbrenner's theory. Understanding mutual interaction between a child and various ecological systems determines how children perceive death and process grief can facilitate effective communication that has significant implications.

Self-harm in young people: risk factors, assessment and treatment interventions

Self-harm, where an individual purposefully harms themselves with a non-fatal outcome, is common, especially among young people. A wide range of mental health issues are associated with self-harm and it increases the likelihood that the person will eventually die by suicide. This article explores the motivations for self-harming behaviours, risk and protective factors, the components of risk assessment and potential interventions. Self-harm can be associated with stigma and discrimination in society and in healthcare services. This article aims to support healthcare practitioners in providing non-judgemental, empathetic and respectful care to these young people and their families and carers.

Escaping the inescapable: Risk of mental health disorder, somatic symptoms and resilience in Palestinian refugee children

Exposure to war, conflict and forced migration puts children at risk of mental health problems. The present study examined the levels of psychological distress and resilience factors among 106 Palestinian refugee children aged 11 to 17 in the West Bank. In a cross-sectional, mixed method design along with qualitative interviews, three questionnaires were administered: the Strength and Difficulties Questionnaire and Patient Health Questionnaire-15, assessed the risk of mental health disorders and psychosomatic complaints, and the Child and Youth Resilience Measure assessed the availability of resilience-enhancing factors. Palestinian refugee children were found to be at greater risk for mental disorders and psychosomatic complaints than were children living in non-conflict affected settings. In addition, resilience-enhancing resources were significantly reduced and were negatively correlated with both symptom outcomes. Risk factors identified included poverty, violence and marginalisation. Key protective factors were youth education, supportive relationships and social participation. Our findings support interventions that address the identified protective factors, which may promote the mental health of this vulnerable population.

Brief training in child and adolescent mental health: Impact on the knowledge and attitudes of pediatric nurses in Nigeria

PROBLEM

Poor knowledge and stigmatizing attitudes of healthcare professionals constitute a significant barrier to child and adolescent mental health care worldwide. This study aimed to determine the effect of a training intervention on the knowledge and attitudes of pediatric nurses to child mental health problems at a Nigerian tertiary hospital.

METHODS

A two group pretest-posttest study design was undertaken. A total of 156 pediatric nurses were recruited, and participants in the intervention group received a brief child mental health training based on the World Health Organization's mhGAP training manual. Knowledge and attitudes to child mental health problems were obtained at baseline, and post intervention.

FINDINGS

There were no differences in knowledge or attitudes across the two groups at baseline. Post intervention, there was a significant increase in the mean post knowledge scores of the intervention group compared with the control group (t = 3.8, p < .001). The effect size of the intervention was 0.62. There were no significant differences in mean post attitude scores across groups.

CONCLUSION

Incorporating children and adolescents mental health competencies into the training of nurses had a modest effect on their knowledge, but limited effect on their attitudes.

Anorexia: a literature review of young people's experiences of hospital treatment

Anorexia nervosa is characterised by significantly low body weight, a fear of weight gain and persistent efforts to prevent the restoration of normal weight. It has potentially life-threatening physical and psychological complications, and many young people with anorexia present to hospital in a seriously compromised physical condition. While their physical symptoms require urgent treatment, addressing their emotional and psychological needs is equally important if they are to progress towards recovery. However, the conflicting thoughts common in anorexia mean that young people often feel highly ambivalent about treatment, which makes the disorder particularly challenging to treat. This article details a literature review undertaken to explore the perceptions and experiences of young people who have received hospital treatment for anorexia, with the aim of offering children's nurses insights into how they can optimally support these patients. The findings demonstrate the importance of listening to young people, treating them as individuals and understanding their experiences, in addition to addressing their physical health needs.

Diagnostic classification of irritability and oppositionality in youth: a global field study comparing ICD-11 with ICD-10 and DSM-5

BACKGROUND

Severe irritability has become an important topic in child and adolescent mental health. Based on the available evidence and on public health considerations, WHO classified chronic irritability within oppositional defiant disorder (ODD) in ICD-11, a solution markedly different from DSM-5's (i.e. the new childhood mood diagnosis, disruptive mood dysregulation disorder [DMDD]) and from ICD-10's (i.e. ODD as one of several conduct disorders without attention to irritability). In this study, we tested the accuracy with which a global, multilingual, multidisciplinary sample of clinicians were able to use the ICD-11 classification of chronic irritability and oppositionality as compared to the ICD-10 and DSM-5 approaches.

METHODS

Clinicians (N = 196) from 48 countries participated in an Internet-based field study in English, Spanish, or Japanese and were randomized to review and use one of the three diagnostic systems. Through experimental manipulation of validated clinical vignettes, we evaluated how well clinicians in each condition could identify chronic irritability versus nonirritable oppositionality, episodic bipolar disorder, dysthymic depression, and normative irritability.

RESULTS

Compared to ICD-10 and DSM-5, ICD-11 led to more accurate identification of severe irritability and better differentiation from boundary presentations. Participants using DSM-5 largely failed to apply the DMDD diagnosis when it was appropriate, and they more often applied psychopathological diagnoses to developmentally normative irritability.

CONCLUSIONS

The formulation of irritability and oppositionality put forth in ICD-11 shows evidence of clinical utility, supporting accurate diagnosis. Global mental health clinicians can readily identify ODD both with and without chronic irritability.

Identification and Management of COVID-19 Related Child and Adolescent Mental Health Problems: A Multi-Tier Intervention Model

Nepal is a low and medium-income country (LMIC), situated in South-east Asia, with a population of 29 million, of which, 40–50% are children and adolescents. The Coronavirus Disease 2019 (COVID-19) pandemic has affected the lives of people around the world, including Nepal. The child and adolescent mental health (CAMH) needs and services in Nepal have a significant gap. CAMH in Nepal suffers from lack of specialized training in this field as well as scarcity of human resources and services. There is only one full-time child and adolescent psychiatry (CAP) out-patient clinic in the country. Some recent activities have focused on CAMH in Nepal but the COVID-19 pandemic has produced new challenges. Access to mental health services for children and adolescents (C&A) across Nepal has been adversely affected. Factors such as closure of schools, confinement at home, lockdown, transportation problems, uncertainty, loss of usual routine and fear of infection have affected the mental health of C&A. This has highlighted a need to build capacity of available local human resources, enhance community support, teach measures of coping with stress and improve CAMH service delivery by strengthening the referral system, but these have to be addressed overcoming problems of travel restrictions and limited resources. To address these needs, online platform can be a suitable approach. With this view, a multi-tier CAMH intervention model was developed, which utilizes online platform for training mental health professionals across Nepal, who would then facilitate sessions for C&A, teachers, parents and caregivers; and link them to CAMH services locally, and remotely through teleconsultation. This started as a pilot from June 2020 and will continue till end of February 2021, with the aim to reach 40,000 C&A, parents, teachers and caregivers. As of Nov 2020, this model has been used to successfully conduct 1,415 sessions, with 28,597 population reached. Among them, 16,571 are C&A and 12,026 are parents, teachers and caregivers, across all 7 provinces of Nepal. In this paper, the multi-tier intervention to address the COVID-19 related CAMH problems has been discussed as a feasible framework for resource limited settings and LMICs like Nepal.

A Systematic Review of Culturally Responsive Approaches to Child and Adolescent Mental Health Care in Ethiopia

In 2012/2013, the prevalence of child mental illness was estimated to be between 12 and 25% in Ethiopia. The Federal Ministry of Health is currently considering the implementation of the second national mental health strategy guided by the World Health Organization's pyramid model for an optimal mix of services. This model states self-care as the fundamental concept and practice that can be facilitated by the formal and informal sectors surrounding an individual. Despite this remarkable move toward endorsing contemporary approaches to mental health services, Ethiopia struggles with a limited number of knowledgeable and skilled mental health professionals. This systematic review aims at identifying the main challenges Ethiopia might face while implementing the pyramid model. We will suggest ways to bridge the gap between the need for child/adolescent trained mental health professionals and training mental health professionals informed with the value of integrating the concepts of the pyramid model into the system of mental health care for Ethiopians. The paper also discusses the importance of integrating the Wellness based mental health approach into mental health professionals' training as a means of developing a culturally responsive approach to child and adolescent services. This review provides implications for further studies and mental health policy, systems and services in Ethiopia.

Planning surgery for young people with learning disabilities

Surgery for spinal deformity is complex and preparation involves a wide multidisciplinary team. For young people with learning disabilities, especially those who have behaviour that challenges, there are further considerations to ensure that their hospital stay is a positive experience and all their additional needs are met. Staff and carers need to be well informed and there must be effective communication. Evaluation of one patient's journey through pre-assessment, surgery and rehabilitation has identified the need for more input from learning disability liaison nurses in acute children's services.

Exploring the effects of being diagnosed with type 1 diabetes in adolescence

Type 1 diabetes is a complex long-term condition for which there is no cure. It can have significant consequences for patients, who need to adapt their lives to a demanding regimen of insulin therapy and will be at risk of various health complications, some of which are potentially fatal. A diagnosis of type 1 diabetes may come as a shock and may be challenging for the patient to accept, and when the condition is diagnosed in adolescence it is likely to compound the challenges many young people experience during this crucial developmental period. This article explores the effects of being diagnosed with type 1 diabetes in adolescence and describes the challenges involved in the management of this condition. It also outlines the role of the nurse in caring for and supporting adolescents with type 1 diabetes.

Evaluating a nurse-led sleep support intervention to reduce melatonin prescribing in children and young people

BACKGROUND

Sleep disturbance, often arising from the way parents manage their child's sleep, affects 40% of children and leads to increased demand on clinical services. Children and young people with significant sleep issues can be treated effectively with a supportive approach but are often prescribed the hormone melatonin because of a lack of available support services.

AIM

To understand the effect and clinical implications of a nurse-led sleep support clinic on melatonin prescribing in children and young people.

METHOD

A retrospective case note evaluation was undertaken of a nurse-led sleep support service delivering a bespoke programme and follow-up support to a patient group of 124 children and young people, 104 of whom had co-morbidities.

RESULTS

A total of 78 (63%) patients were successfully discharged without melatonin prescriptions after a median of two face-to-face clinic visits and three telephone calls. Eleven out of 12 patients had not restarted melatonin after 12 months.

CONCLUSION

A nurse-led, non-pharmacological approach to sleep support in children and young people can provide an effective, sustainable alternative to melatonin prescribing. The authors recommend that appropriate sleep support should be administered and the response reviewed before melatonin is prescribed. Investment in sleep services to support this approach is important.

Review of the clinical approach to the treatment of disruptive mood dysregulation disorder

Though a decade of research led to the creation of disruptive mood dysregulation disorder (DMDD), it was not until the 2013 publication of the DSM-5 that DMDD became an official diagnosis. The conception of DMDD was largely due to increasing rates of paediatric bipolar disorder (PBD) diagnoses, which significantly impacted treatment for these youth. The core symptoms of DMDD include persistent irritability and recurrent outbursts; the absence of a previous diagnostic category for youth experiencing these symptoms may have led to the over diagnosis of PBD. Due to the chronicity of symptoms, these youth are impaired in multiple areas of functioning. This article will present background information about DMDD, discuss clinical assessment strategies including scales for measuring irritability and aggression, and review pharmacologic and psychosocial treatments for youth with DMDD and clinical phenotypes similar to DMDD.

Role of school nurses in identifying and supporting children and young people with mental health issues

School nurses have an important role in the provision of mental health services because of their expertise in healthcare and education. The aim of this literature review was to explore research about school nurses' ability to identify and support children and young people in secondary education with mental health issues. A search of healthcare-related databases was undertaken using search terms such as 'specialist community public health nurse' (SCPHN), 'school nurses', 'young people', mental health' and 'adolescent mental health' to identify relevant research. The literature review found that school nurses perform various activities for children and young people, for example promoting optimal mental health, identifying concerns and initiating early interventions. However, the literature review also suggests that unless school nurses receive further education in mental health they will be unable to develop the necessary skills required to improve outcomes for children and young people in secondary education.