Structural Inequities and the Impact of COVID-19 on Latinx Children: Implications for Child and Adolescent Mental Health Practice

IntroductionIncreased demand for Child and Adolescent Mental Health Services (CAMHS), alongside concerns that services should be better commissioned to meet the needs of the most vulnerable, has contributed to a requirement to transform services to improve accessibility, quality of care and health outcomes. Following the submission of government-mandated transformation plans for CAMHS, services in England are changing in how, where and by whom they are delivered. This protocol describes the research methods to be applied to understand CAMHS transformations and evaluate the impact on the use of mental health services, patient care, satisfaction, health outcomes and health resource utilisation costs.Methods and analysisA mixed-methods approach will be taken in an observational retrospective study of CAMHS provided by a large National Health Service (NHS) mental health trust in South-East England (Oxford Health NHS Foundation Trust). Quantitative research will include descriptive analysis of routinely collected data, with difference-in-differences analysis supplemented with propensity score matching performed to assess the impact of CAMHS transformations from 2015 onwards. An economic evaluation will be conducted from a healthcare perspective to provide commissioners with indications of value for money. Qualitative research will include observations of services and interviews with key stakeholders including CAMHS staff, service users and guardians, to help identify mechanisms leading to changes in service delivery, as well as barriers and enabling factors in this phase of transformation.Ethics and disseminationThis project has been registered with NHS Oxford Health Foundation Trust as a service evaluation. Informed consent will be sought from all stakeholders partaking in interviews according to good clinical practice. A local data sharing protocol will govern the transfer of quantitative data. Study findings will be published in professional journals for NHS managers and peer-reviewed scientific journals. They will be discussed in seminars targeting CAMHS providers, managers and commissioners and presented at scientific conferences.

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The relationship between exclusion from school and mental health: a secondary analysis of the British Child and Adolescent Mental Health Surveys 2004 and 2007

Psychological Medicine ◽

10.1017/s003329171700215x ◽

2017 ◽

Vol 48 (4) ◽

pp. 629-641 ◽

Cited By ~ 12

Author(s):

T. Ford ◽

C. Parker ◽

J. Salim ◽

R. Goodman ◽

S. Logan ◽

...

Keyword(s):

Mental Health ◽

Psychological Distress ◽

Psychiatric Disorder ◽

Health Surveys ◽

Secondary Analysis ◽

Adolescent Mental Health ◽

Child And Adolescent ◽

The Impact ◽

The Relationship

BackgroundChildren with poor mental health often struggle at school. The relationship between childhood psychiatric disorder and exclusion from school has not been frequently studied, but both are associated with poor adult outcomes. We undertook a secondary analysis of the British Child and Adolescent Mental Health Surveys from 2004 and its follow-up in 2007 to explore the relationship between exclusion from school and psychopathology. We predicted poorer mental health among those excluded.MethodPsychopathology was measured using the Strengths and Difficulties Questionnaire, while psychiatric disorder was assessed using the Development and Well-Being Assessment and applying Diagnostic and Statistical Manual of Mental Disorders Fourth Edition (DSM IV) criteria. Exclusion from school and socio-demographic characteristics were reported by parents. Multi-variable regression models were used to examine the impact of individual factors on exclusion from school or psychological distress.ResultsExclusion from school was commoner among boys, secondary school pupils and those living in socio-economically deprived circumstances. Poor general health and learning disability among children and poor parental mental health were also associated with exclusion. There were consistently high levels of psychological distress among those who had experienced exclusion at baseline and follow-up.ConclusionsWe detected a bi-directional association between psychological distress and exclusion. Efforts to identify and support children who struggle with school may therefore prevent both future exclusion and future psychiatric disorder.

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Productivity growth in outpatient child and adolescent mental health services: The impact of case-mix adjustment

Social Science & Medicine ◽

10.1016/j.socscimed.2009.11.002 ◽

2010 ◽

Vol 70 (3) ◽

pp. 439-446 ◽

Cited By ~ 11

Author(s):

Vidar Halsteinli ◽

Sverre A. Kittelsen ◽

Jon Magnussen

Keyword(s):

Mental Health ◽

Mental Health Services ◽

Health Services ◽

Productivity Growth ◽

Adolescent Mental Health ◽

Child And Adolescent ◽

Case Mix ◽

Case Mix Adjustment ◽

The Impact

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The use of HoNOSCA in a child and adolescent mental health service

Irish Journal of Psychological Medicine ◽

10.1017/s0790966700007618 ◽

2003 ◽

Vol 20 (2) ◽

pp. 52-55 ◽

Cited By ~ 11

Author(s):

Julie Manderson ◽

Noel McCune

Keyword(s):

Mental Health ◽

Mental Health Service ◽

Health Service ◽

Peer Relationships ◽

Aggressive Behaviour ◽

Adolescent Mental Health ◽

Child And Adolescent ◽

Initial Assessment ◽

Adolescent Mental Health Service ◽

The Impact

AbstractObjectives: To assess the health and social functioning of patients attending a Child and Adolescent Mental Health Service (CAMHS) and to measure the impact of attendance using the Health of the Nation Outcome Scales for Children and Adolescents (HoNOSCA).Method: HoNOSCA was completed on 73 consecutive patients attending for initial assessment with a review assessment being completed after six months or at discharge from the clinic if this occurred sooner on 53 of these. The impact of attendance at the clinics was determined by comparing initial and review mean HoNOSCA Scores.Results: Of the 53, 66% were male and 34% female. Boys were more highly rated with regard to aggressive behaviour, performance in peer relationships and family life relationships whilst girls were rated as having more nonorganic and emotional symptoms. Older children showed the highest rates of poor school attendance, non accidental (self) injury and emotional problems while younger children showed the greatest aggressive behaviour and language skill problems. An improvement in the total HoNOSCA score from initial assessment to review was seen in 92%. There was an improvement in the HoNOSCA mean score from initial assessment to review.Conclusions: Age, sex and symptom profiles of patients attending the service were similar to other CAMHS. Attendance at CAMHS produces improvements in patient outcomes over a six month period as measured using HoNOSCA, which proved to be a useful if somewhat time consuming tool.

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Mentally disordered young offenders in transition from child and adolescent to adult mental health services across England and Wales

Journal of Forensic Practice ◽

10.1108/jfp-01-2017-0002 ◽

2017 ◽

Vol 19 (4) ◽

pp. 301-308 ◽

Cited By ~ 2

Author(s):

Maria I. Livanou ◽

Vivek Furtado ◽

Swaran P. Singh

Keyword(s):

Mental Health ◽

Mental Health Services ◽

Health Services ◽

Adolescent Mental Health ◽

Child And Adolescent ◽

Young Offenders ◽

England And Wales ◽

Content Type ◽

Health And Wellbeing ◽

The Impact

Purpose This paper provides an overview of transitions across forensic child and adolescent mental health services in England and Wales. The purpose of this paper is to delineate the national secure services system for young people in contact with the youth justice system. Design/methodology/approach This paper reviews findings from the existing literature of transitions across forensic child and adolescent mental health services, drawing attention to present facilitators and barriers to optimal transition. The authors examine the infrastructure of current services and highlight gaps between child and adult service continuity and evaluate the impact of poor transitions on young offenders’ mental health and wellbeing. Findings Young offenders experience a broad range of difficulties, from the multiple interfaces with the legal system, untreated mental health problems, and poor transition to adult services. Barriers such as long waiting lists, lack of coordination between services and lack of transition preparation impede significantly smooth transitions. Research limitations/implications The authors need to develop, test and evaluate models of transitional care that improve mental health and wellbeing of this group. Practical implications Mapping young offenders’ care pathway will help to understand their needs and also to impact current policy and practice. Key workers in forensic services should facilitate the transition process by developing sustainable relationships with the young person and creating a safe clinical environment. Originality/value Transition of care from forensic child and adolescent mental health services is a neglected area. This paper attempts to highlight the nature and magnitude of the problems at the transition interface in a forensic context.

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