scholarly journals Referral patterns to outpatient child and adolescent mental health services and factors associated with referrals being rejected. A cross-sectional observational study

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Anna Sofie Hansen ◽  
Cecilie Haugaard Christoffersen ◽  
Gry Kjaersdam Telléus ◽  
Marlene Briciet Lauritsen
Keyword(s):  
Mental Health ◽  
Mental Health Services ◽  
Health Services ◽  
Observational Study ◽  
General Practitioners ◽  
Child And Adolescent ◽  
Cross Sectional ◽  
Referral Patterns ◽  
Factors Associated ◽  
Increased Risk

Abstract Background Outpatient child and adolescent mental health services (CAMHS) are faced with the challenge of balancing increasing demands with limited resources. An additional challenge is high rejection rates of referrals which causes frustration for referring agents and families. In order to effectively plan and allocate available resources within CAMHS there is a need for up-to-date knowledge on referral patterns and factors associated with rejection of referrals. Methods In this cross-sectional observational study we did a retrospective review of all referrals (n = 1825) for children (0–18) referred for assessment at the outpatient CAMHS of the North Denmark Region in 2018. Results The most common referral reasons to CAMHS were attention deficit disorder (ADHD/ADD) (27.9%), autism spectrum disorder (22.4%), affective disorders (14.0%) and anxiety disorders (11.6%). The majority of referrals came from general practitioners, but for neurodevelopmental disorders educational psychologists were the primary referral source. Re-referrals constituted more than a third of all referrals (35.9%). Children in care were overrepresented in this clinical sample and had an increased risk (Adj. OR 2.54) of having their referrals rejected by CAMHS. Referrals from general practitioners were also associated with an increased risk of rejection (Adj. OR 3.29). Conclusions A high proportion of children with mental disorders have a repeated need for assessment by CAMHS. There is a need for future research on predictors of re-referral to outpatient services to identify potential targets for reducing re-referral rates as well as research on how to optimize service provision for children with a repeated need for assessment. General practitioners are the main gatekeepers to CAMHS and research on interventions to improve the referral process should be aimed towards general practitioners.

scholarly journals Burnout in consultants in child and adolescent mental health services (CAMHS) in Ireland: a cross-sectional study

BMJ Open ◽  
2020 ◽  
Vol 10 (1) ◽  
pp. e030354 ◽  
Author(s):  
Fiona McNicholas ◽  
Sonita Sharma ◽  
Cliodhna Oconnor ◽  
Elizabeth Barrett
Keyword(s):  
Mental Health ◽  
Mental Health Services ◽  
Health Services ◽  
Child Psychiatry ◽  
Well Being ◽  
Adolescent Mental Health ◽  
Child And Adolescent ◽  
Medical Council ◽  
Cross Sectional ◽  
Child Psychiatrists

Physician burnout has reached epidemic levels in many countries, contributing to adverse personal, patient and service outcomes. Adverse socioeconomic conditions, such as the economic downturn in the Ireland post 2008, contribute to a situation of increased demand but inadequate resources. Given a recent unprecedented increase in referrals to Irish child and adolescent mental health services (CAMHS), coupled with a fragmented and poorly resourced service, it is important to reflect on consultant child psychiatrists’ well-being.ObjectivesTo report on the level of burnout among consultants working in CAMHS in Ireland using a cross-sectional design.SettingCommunity CAMHS in Ireland.ParticipantsAn online questionnaire was sent to all consultant child psychiatrists registered with the Irish Medical Council (n=112). Fifty-two consultants replied (46% response rate).Primary outcome measuresQuestions assessed demographic and occupational details, career satisfaction and perceived management, government and public support. The Copenhagen Burnout Inventory measured personal, work and patient-related burnout.ResultsThe prevalence of moderate or higher levels of work-related and personal burnout was 75% and 72.3%, respectively. Fewer (n=14, 26.9%) experienced patient-related burnout. There was a strong correlation between work burnout and personal (r=0.851, n=52, p<0.001) and patient-related burnout (r=0.476, n=52, p<0.001). Lack of confidence in government commitment to investment in CAMHS (p<0.001) and perceived ineffective management by health authorities (p=0.002) were associated with higher burnout scores. Few consultants (n=11, 21%) felt valued in their job. The majority (n=36, 69%) had seriously considered changing jobs, and this was positively associated with higher burnout (p<0.001). Higher burnout scores were present in those (n=15, 28.8%) who would not retrain in child psychiatry (p=0.002).ConclusionThe high level of burnout reported by respondents in this study, and ambivalence about child psychiatry as a career choice has huge professional and service implications. Urgent organisational intervention to support consultant psychiatrists’ well-being is required.

Factors Associated with Dropout and Diagnosis in Child and Adolescent Mental Health Services

2009 ◽  
Vol 43 (5) ◽  
pp. 431-437 ◽  
Author(s):  
Emily Johnson ◽  
David Mellor ◽  
Peter Brann
Keyword(s):  
Mental Health ◽  
Mental Health Service ◽  
Mental Health Services ◽  
Health Service ◽  
Health Services ◽  
Adolescent Mental Health ◽  
Child And Adolescent ◽  
Factors Associated ◽  
Mental Health Settings ◽  
Adolescent Mental Health Service

Objective: Dropout from child and adolescent mental health services has ramifications for children, families and the services themselves. Understanding the factors that are associated with dropout for different diagnoses has the potential to assist with tailoring of services to reduce dropout. The aim of the current study was to identify such factors. Method: A file audit was conducted for all referrals to a child and adolescent mental health service over a 12 month period, yielding 520 subjects for analysis (264 male, 256 female, mean age = 12.6 years). Parent, child and service variables of interest were recorded as were diagnoses, which were categorized into 25 superordinate categories. Results: Almost 50% of subjects dropped out of treatment. Factors associated with dropout varied across diagnosis, and no factor was associated with dropout for all diagnoses. Conclusion: There are differences in the factors that were associated with dropout for different disorders. This is a useful finding in terms of understanding and preventing dropout in child and adolescent mental health settings, but more research is needed.

scholarly journals Variation in spend on young mental health across Clinical Commissioning Groups in England: a cross-sectional observational study

BMJ Open ◽  
2019 ◽  
Vol 9 (10) ◽  
pp. e030011 ◽  
Author(s):  
Stephen Rocks ◽  
Mina Fazel ◽  
Apostolos Tsiachristas
Keyword(s):  
Mental Health ◽  
Mental Health Services ◽  
Health Services ◽  
Physical Health ◽  
Adolescent Mental Health ◽  
Child And Adolescent ◽  
Young Person ◽  
Cross Sectional ◽  
Adult Mental Health ◽  
Children In Care

ObjectivesTo investigate whether the rate of spend on child and adolescent mental health is influenced by demand for other competing services in local commissioning decisions.DesignAnalysis of spend data by Clinical Commissioning Groups (CCG), including other publicly available data to control for variation in need.SettingLocal commissioning decisions in the National Health Service.ParticipantsCommissioning of health services across 209 CCGs.Main outcome measuresAssociation between the rate of child and adolescent mental health spend and demand for child and adolescent mental health services (CAMHS), adult mental health services and physical health services after adjusting for confounding factors.ResultsAn additional percentage point in the proportion of children in care is associated with 4% higher child and young person mental health (CYP MH) spend per person aged 0–18 (ratio of means: 1.04; 95% CI 1.00 to 1.07). Spending £100 more on physical health services was associated with 9% lower spend in CYP MH per person aged 0–18 (ratio of means: 0.91; 95% CI 0.84 to 0.99).ConclusionsHealthcare commissioners in England face a challenge in balancing competing needs. This paper contributes to our understanding of this by quantifying the possible extent of the trade-off between physical health and CYP MH when allocating budgets. Any attempt to explain the variation in CAMHS spend must also take account of demand for other services.

Impact of training for general practitioners on their mental health services: The Hong Kong experience

2018 ◽  
Vol 47 (8) ◽  
pp. 550-555 ◽  
Author(s):  
Tai Pong Lam ◽  
Kai Sing Sun ◽  
Leon Piterman ◽  
Kwok Fai Lam ◽  
Man Kay Poon ◽  
...  
Keyword(s):  
Mental Health ◽  
Hong Kong ◽  
Mental Health Services ◽  
Health Services ◽  
General Practitioners

Making sense of child and adolescent mental health services (CAMHS): An audit of the referral journey and the use of routine outcome measures (ROMS)

2021 ◽  
pp. 135910452199970
Author(s):  
Naomi Gibbons ◽  
Emma Harrison ◽  
Paul Stallard
Keyword(s):  
Mental Health ◽  
Mental Health Services ◽  
Health Services ◽  
Outcome Measures ◽  
Adolescent Mental Health ◽  
Child And Adolescent ◽  
Completion Rates ◽  
Making Sense ◽  
North East ◽  
Over Time

Background: There is increased emphasis on the national reporting of Routine Outcome Measures (ROMS) as a way of improving Child and Adolescent Mental Health Services (CAMHS). This data needs to be viewed in context so that reasons for outcome completion rates are understood and monitored over time. Method: We undertook an in-depth prospective audit of consecutive referrals accepted into the Bath and North East Somerset, Swindon and Wiltshire (BSW) CAMHS service from November 2017 to January 2018 ( n = 1074) and April to September 2019 ( n = 1172). Results: Across both audits 90% of those offered an appointment were seen with three quarters completing baseline ROMS. One in three were not seen again with around 30% still being open to the service at the end of each audit. Of those closed to the service, paired ROMS were obtained for 46% to 60% of cases. There were few changes in referral problems or complexity factors over time. Conclusion: Understanding the referral journey and the reasons for attrition will help to put nationally collected data in context and can inform and monitor service transformation over time.

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