Associations between evidence-based practice and mental health outcomes in child and adolescent mental health services

Professionals working in child and adolescent mental health services are increasingly encouraged to examine the evidence underlying their clinical practice. Embracing evidence-based practice can present difficulties, as barriers to changing practice exist. These difficulties are examined, along with the meaning of evidence-based practice in a multidisciplinary speciality, and the potential benefits that develop from it.

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Understanding and evaluating new models of Child and Adolescent Mental Health Services in South-East England: a study protocol for an observational mixed-methods study

BMJ Open ◽

10.1136/bmjopen-2018-024230 ◽

2018 ◽

Vol 8 (12) ◽

pp. e024230 ◽

Cited By ~ 2

Author(s):

Stephen Rocks ◽

Melissa Stepney ◽

Margaret Glogowska ◽

Mina Fazel ◽

Apostolos Tsiachristas

Keyword(s):

Mental Health ◽

Mixed Methods ◽

Mental Health Services ◽

Health Services ◽

Health Outcomes ◽

Adolescent Mental Health ◽

Child And Adolescent ◽

Resource Utilisation ◽

South East England ◽

The Impact

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 management of young people who self-harm by New Zealand Infant, Child and Adolescent Mental Health Services: cutting-edge or cutting corners?

Australasian Psychiatry ◽

10.1177/1039856217748248 ◽

2018 ◽

Vol 26 (2) ◽

pp. 152-159

Author(s):

Hiran Thabrew ◽

Ernest Gandeza ◽

Giselle Bahr ◽

David Bettany ◽

Chris Bampton ◽

...

Keyword(s):

Mental Health ◽

New Zealand ◽

Mental Health Services ◽

Young People ◽

Health Services ◽

Adolescent Mental Health ◽

Child And Adolescent ◽

Evidence Based ◽

Behaviour Therapy ◽

Self Harm

Objectives: Self-harm is common in New Zealand (NZ) young people and can have short-term and long-term consequences, including suicide. This study was undertaken to examine the extent to which evidence-based approaches for addressing self-harm are offered by Infant, Child and Adolescent Mental Health Services (ICAMHS). Methods: A national survey of ICAMHS practitioners working with young people who self-harm was undertaken between May and July 2016. Results: Responses from 23 out of 30 ICAMHS confirmed self-harm was a familiar presentation and most commonly associated with diagnoses of depression, anxiety and borderline personality disorder. Cognitive behavioural therapy (47.1%, n = 8), dialectical behaviour therapy (47.1%, n = 8) and acceptance and commitment therapy (5.9%, n = 1) were the treatments of choice, but variably delivered. There were significant training gaps for all types of therapy. Conclusions: Although it is reassuring that many ICAMHS are using evidence-based approaches to address self-harm in young people, there is concerning variability in the way these therapies are delivered. Improvement in training in key modalities, further research into therapist performance and continuous evaluation of workforce development are needed to maximise the effectiveness of proven interventions and provide NZ young people with the state-of-the-art service they deserve.

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Local, Early, and Precise: Designing a Clinical Decision Support System for Child and Adolescent Mental Health Services

Frontiers in Psychiatry ◽

10.3389/fpsyt.2020.564205 ◽

2020 ◽

Vol 11 ◽

Author(s):

Thomas Brox Røst ◽

Carolyn Clausen ◽

Øystein Nytrø ◽

Roman Koposov ◽

Bennett Leventhal ◽

...

Keyword(s):

Mental Health ◽

Mental Health Services ◽

Health Services ◽

Clinical Decision ◽

Adolescent Mental Health ◽

Child And Adolescent ◽

Mental Health Disorders ◽

Evidence Based ◽

Health Disorders

Mental health disorders often develop during childhood and adolescence, causing long term and debilitating impacts at individual and societal levels. Local, early, and precise assessment and evidence-based treatment are key to achieve positive mental health outcomes and to avoid long-term care. Technological advancements, such as computerized Clinical Decision Support Systems (CDSSs), can support practitioners in providing evidence-based care. While previous studies have found CDSS implementation helps to improve aspects of medical care, evidence is limited on its use for child and adolescent mental health care. This paper presents challenges and opportunities for adapting CDSS design and implementation to child and adolescent mental health services (CAMHS). To highlight the complexity of incorporating CDSSs within local CAMHS, we have structured the paper around four components to consider before designing and implementing the CDSS: supporting collaboration among multiple stakeholders involved in care; optimally using health data; accounting for comorbidities; and addressing the temporality of patient care. The proposed perspective is presented within the context of the child and adolescent mental health services in Norway and an ongoing Norwegian innovative research project, the Individualized Digital DEcision Assist System (IDDEAS), for child and adolescent mental health disorders. Attention deficit hyperactivity disorder (ADHD) among children and adolescents serves as the case example. The integration of IDDEAS in Norway intends to yield significantly improved outcomes for children and adolescents with enduring mental health disorders, and ultimately serve as an educational opportunity for future international approaches to such CDSS design and implementation.

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Commentary: Evidence-Based Child and Adolescent Mental Health Services

Child and Adolescent Mental Health ◽

10.1111/1475-3588.00323 ◽

2001 ◽

Vol 6 (2) ◽

pp. 65-65

Author(s):

Richard Harrington

Keyword(s):

Mental Health ◽

Mental Health Services ◽

Health Services ◽

Adolescent Mental Health ◽

Child And Adolescent ◽

Evidence Based

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Commentary: Evidence-Based Child and Adolescent Mental Health Services

Child Psychology and Psychiatry Review ◽

10.1017/s1360641701002519 ◽

2001 ◽

Vol 6 (2) ◽

pp. 65-65 ◽

Cited By ~ 1

Author(s):

Richard Harrington

Keyword(s):

Mental Health ◽

Mental Health Services ◽

Health Services ◽

Quantitative Methods ◽

Adolescent Mental Health ◽

Child And Adolescent ◽

Current Debate ◽

Health Practitioner ◽

Evidence Based ◽

Randomised Trials

The argument for evidence-based child and adolescent mental health services is irresistible. Indeed, I have yet to meet a mental health practitioner who has told me that his or her work was not based on evidence. The exam question, however, is ‘what is the best evidence?’ In a helpful contribution to the current debate about evidence-based practice, Ramchandani, Joughin and Zwi point out that the answer depends on what the question was in the first place. They argue that while some clinical questions are best tackled using quantitative methods such as randomised trials, other questions are better answered using different techniques. Traditional hierarchies of evidence that give primacy to randomised trials may not always be appropriate to child mental health practice.

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