scholarly journals Reducing aggression and improving offending outcomes in youth with conduct disorder, results of a systematic review

BJPsych Open ◽  
2021 ◽  
Vol 7 (S1) ◽  
pp. S270-S270
Author(s):  
Craig McEwan ◽  
Lauren Dunn ◽  
Jake Harvey
Keyword(s):  
Mental Health ◽  
Mental Health Services ◽  
Health Services ◽  
Conduct Disorder ◽  
Antisocial Behaviour ◽  
Target Population ◽  
Evidence Base ◽  
Data Set ◽  
Effective Prevention ◽  
Offending Behaviour

AimsThe aim of this literature review was to determine what interventions are effective in reducing aggression and offending behaviour in under 18's with conduct disorder.Null hypothesis: There is no difference in aggression or offending behaviour in under 18's with conduct problems in spite of interventions offeredBackgroundMental health services for children and adolescents who are aggressive or who have come into contact with the Youth Justice System are sparse and often under resourced. Conduct disorder (CD) is one of the most frequently diagnosed conditions in adolescents, particularly in young offenders (Kenny et al 2007). The most effective prevention programs for youth at risk of persistent delinquency has previously been found to be a multi model program focussing on the family context. However, this has not taken in to consideration the extent and prevalence of mental disorder, including conduct disorder, within the target population.MethodA systematic literature search was undertaken on medline and psychoinfo between January and December 2018. Identified papers were then screened by two independent researchers against pre-agreed inclusion and exclusion criteria. Relevant papers were assessed for bias and results summarised.ResultFrom an initial data set of 526 papers, 9 were included for review. 4 focussed on psychopharmacology (1 aripiprazole, 1 risperidone, 1 risperidone vs clozapine, 1 clozapine), 1 family centred feedback, 1 Mode Deactivation Therapy and 3 were multi modal (combinations of Mode Deactivation Therapy, Stop Now and Act Programme, CBT, Didactic sessions, 1:1 counselling). None of the multi-modal interventions were standardised or comparable to each other. End points varied from 8 weeks (aripiprazole) to 15 months (multimodal SNAP programme). Settings varied from community programmes to secure inpatient settings. Whilst one risperidone study reported it to be effective in reducing aggression, it was not significant. One SNAP (multimodal) programme failed to show significant effect. All other 7 interventions, across various methods, demonstrated significant reductions in aggression, violence or other antisocial behaviour.ConclusionFew papers were identified that assessed interventions for youth with conduct disorder. The papers that were identified were significantly heterogeneous in their intervention, sample selection, methodology and outcome measures. Unfortunately, this leads to an inability to compare any interventions for this demographic. Despite the rise in Forensic Child and Adolescent Mental Health Services, there is a weak and poorly understood evidence base for supporting and managing young people with conduct disorder.

scholarly journals Child and adolescent mental health services liaison with Tier 1 services: a consultation exercise with school nurses

2000 ◽  
Vol 24 (12) ◽  
pp. 462-463 ◽  
Author(s):  
Greg Richardson ◽  
Ian Partridge
Keyword(s):  
Mental Health ◽  
Mental Health Services ◽  
Health Services ◽  
Adolescent Mental Health ◽  
Child And Adolescent ◽  
Evidence Base ◽  
Audit Commission ◽  
Tier 1 ◽  
Tiered System ◽  
Consultation Intervention

Consultation with Tier 1 professionals is an integral part of comprehensive child and adolescent mental health services (CAMHS) (NHS Health Advisory Service, 1995; Audit Commission, 1999). Despite enthusiasm for consultative approaches and clearly described advantages (Steinberg, 1993), the evidence base for consultation work is thin. In schools, the consultation intervention has been found to be the least effective of four interventions (Kolvin et al, 1981). Consultation enables the development of an integrated tiered system, improves communication, provides a greater understanding of the roles of CAMHS by Tier 1 professionals and fosters more relevant referral patterns.

Telemental health

2018 ◽  
pp. 531-538 ◽  
Author(s):  
Maryann Waugh ◽  
Matthew Mishkind ◽  
Jay H. Shore
Keyword(s):  
Mental Health ◽  
Mental Health Services ◽  
Health Services ◽  
Positive Impact ◽  
Care Delivery ◽  
Public Mental Health ◽  
Evidence Base ◽  
Physical Distance ◽  
Telemental Health ◽  
System P

Telemental health is a term for health care that leverages audio and video telecommunications technologies such as video-teleconferencing, computers, mobile devices, the Internet, telephones, and broadband connectivity to provide mental health services across time and physical distance. Telemental health has the capacity to make a significant and positive impact on public mental health by its ability to not only increase access to care, but also more effectively tailor mental health services to individual or community-wide healthcare needs. This chapter describes ways that telemental health is currently being used to impact mental health promotion, prevention, and treatment, summarizes the evidence base for these applications, and highlights some practical considerations for providers and systems implementing this newer virtual care delivery system.

scholarly journals Causal Modelling for Supporting Planning and Management of Mental Health Services and Systems: A Systematic Review.

2019 ◽  
Vol 16 (3) ◽  
pp. 332 ◽  
Author(s):  
Nerea Almeda ◽  
Carlos R. García-Alonso ◽  
José A. Salinas-Pérez ◽  
Mencía R. Gutiérrez-Colosía ◽  
Luis Salvador-Carulla
Keyword(s):  
Mental Health ◽  
Decision Making ◽  
Mental Health Services ◽  
Health Services ◽  
Policy Making ◽  
Structural Equation ◽  
Target Population ◽  
Performance Factors ◽  
Causal Modelling

Mental health services and systems (MHSS) are characterized by their complexity. Causal modelling is a tool for decision-making based on identifying critical variables and their causal relationships. In the last two decades, great efforts have been made to provide integrated and balanced mental health care, but there is no a clear systematization of causal links among MHSS variables. This study aims to review the empirical background of causal modelling applications (Bayesian networks and structural equation modelling) for MHSS management. The study followed the PRISMA guidelines (PROSPERO: CRD42018102518). The quality of the studies was assessed by using a new checklist based on MHSS structure, target population, resources, outcomes, and methodology. Seven out of 1847 studies fulfilled the inclusion criteria. After the review, the selected papers showed very different objectives and subjects of study. This finding seems to indicate that causal modelling has potential to be relevant for decision-making. The main findings provided information about the complexity of the analyzed systems, distinguishing whether they analyzed a single MHSS or a group of MHSSs. The discriminative power of the checklist for quality assessment was evaluated, with positive results. This review identified relevant strategies for policy-making. Causal modelling can be used for better understanding the MHSS behavior, identifying service performance factors, and improving evidence-informed policy-making.

scholarly journals Evaluation of ReachOut.com, an Unstructured Digital Youth Mental Health Intervention: Prospective Cohort Study

10.2196/21280 ◽  
2020 ◽  
Vol 7 (10) ◽  
pp. e21280
Author(s):  
Bianca Lorraine Kahl ◽  
Hilary May Miller ◽  
Kathryn Cairns ◽  
Hayley Giniunas ◽  
Mariesa Nicholas
Keyword(s):  
Mental Health ◽  
Mental Health Services ◽  
Young People ◽  
Health Services ◽  
Retention Rate ◽  
Well Being ◽  
Evidence Base ◽  
Preliminary Evidence ◽  
Health Intervention ◽  
Mental Health Intervention

Background Young people experience a disproportionate burden associated with mental illness that Australia’s mental health care system is ill-equipped to handle. Despite improvements in the provision of mental health services, the rates of service utilization among young people remain suboptimal, and there are still considerable barriers to seeking help. Digital mental health services can overcome a number of barriers and connect young people requiring support; however, the evidence base of digital interventions is limited. Objective The aim of this study is to examine the effectiveness of a brief, self-directed, unstructured digital intervention, ReachOut.com (hereafter ReachOut), in reducing depression, anxiety, stress, and risk of suicide. Methods A cohort of 1982 ReachOut users participated in a 12-week longitudinal study, with a retention rate of 81.18% (1609/1982) across the duration of the study. Participants completed web-based surveys, with outcome measures of mental health status and suicide risk assessed at 3 time points across the study period. Results The results demonstrated that over the 12-week study period, young people using ReachOut experienced modest yet significant reductions in symptoms of depression, anxiety, and stress. Significant, albeit modest, reductions in the proportion of participants at high risk of suicide were also observed. Conclusions The findings of this research provide preliminary evidence of the promise of an unstructured digital mental health intervention, ReachOut, in alleviating symptoms of mental ill-health and promoting well-being in young people. These findings are particularly important given that digital services are not only acceptable and accessible but also have the potential to cater to the diverse mental health needs of young people at scale, in a way that other services cannot.

scholarly journals Perspectives on Recruitment and Representativeness in Forensic Psychiatric Research

2021 ◽  
Vol 12 ◽  
Author(s):  
Sven H. Pedersen ◽  
Henrik Bergman ◽  
Johan Berlin ◽  
Thomas Hartvigsson
Keyword(s):  
Mental Health ◽  
Mental Health Services ◽  
Health Services ◽  
Statistical Power ◽  
Evidence Base ◽  
Mental Health Research ◽  
Psychiatric Research ◽  
Forensic Mental Health ◽  
Research Participants ◽  
Forensic Psychiatric

Participant representativeness and statistical power are crucial elements of robust research with human participants, both of which relate to the successful recruitment of research participants. Nevertheless, such core features may often not be fully reported or duly considered in psychiatric research. Building on our experiences of collecting data in the context of forensic mental health services, we discuss issues regarding participant recruitment and representativeness in our field with its particular characteristics. A quick sampling and brief overview of the literature in four specialized forensic mental health journals is presented, demonstrating that published manuscripts rarely describe the data in sufficient detail for the reader to assess sample representativeness and statistical power. This lack of transparency leads not only to difficulties in interpreting the research; it also entails risks relating to the already meager evidence base of forensic mental health services being relevant only to a subset of patients. Accordingly, we provide suggestions for increased transparency in reporting and improved recruitment of research participants. We also discuss the balance of ethical considerations pertinent to the pursuit of increased participation rates in forensic mental health research.

scholarly journals An evaluation of predictors of dropout from an Emotional Coping Skills programme in a community mental health service

2019 ◽  
Vol 12 ◽  
Author(s):  
Shalini Raman ◽  
Thomas Richardson
Keyword(s):  
Mental Health ◽  
Mental Health Services ◽  
Community Mental Health ◽  
Health Services ◽  
Coping Skills ◽  
Evidence Base ◽  
Drop Out ◽  
List Type ◽  
Client Retention ◽  
Emotional Coping

Abstract Drop-out from mental health services is a significant problem, leading to inefficient use of resources and poorer outcomes for clients. Adapted dialectical behaviour therapy (DBT), often termed Emotional Coping Skills (ECS) programmes, show some of the highest rates of drop-out from therapy recorded in the literature. The present study aimed to add to the evidence base, by evaluating predictors of drop-out from an ECS programme in a UK-based Community Mental Health Team (CMHT). An existing data set of 49 clients, consisting of clients’ responses on a number of questionnaires, was evaluated for predictors of drop-out. Predictors of drop-out included symptom severity, substance use and client demographics. Independent-samples t-tests and chi-square cross tabs analyses revealed no significant differences between drop-outs and completers of therapy on any of the variables. This suggests that contrary to common assumptions and previous findings, clients using substances, who are highly anxious, or who experience a greater degree of emotion dysregulation, are not more likely to drop out from ECS programmes compared with other individuals. The clinical implications of these findings and future research are discussed within the wider context of the evidence base. Key learning aims (1) To be familiar with common predictors of drop-out from psychological therapies, as indicated by the literature. (2) To understand the theories underlying factors that impact drop-out and the associated consequences for mental health services. (3) To understand the potential impact of staff assumptions of factors that affect drop-out on client retention. (4) To have an understanding of initiatives and strategies that may improve client-retention and engagement in services.

scholarly journals The effectiveness of one-to-one peer support in mental health services: a systematic review and meta-analysis

2020 ◽  
Vol 20 (1) ◽  
Author(s):  
Sarah White ◽  
Rhiannon Foster ◽  
Jacqueline Marks ◽  
Rosaleen Morshead ◽  
Lucy Goldsmith ◽  
...  
Keyword(s):  
Mental Health ◽  
Mental Health Services ◽  
Health Services ◽  
Peer Support ◽  
Service Use ◽  
Positive Impact ◽  
Evidence Base ◽  
Risk Of Bias ◽  
One To One ◽  
Meta Analyses

Abstract Background Peer support is being introduced into mental health services internationally, often in response to workforce policy. Earlier systematic reviews incorporate different modalities of peer support (i.e. group and one-to-one), offer inconsistent evidence of effectiveness, and also indicate substantial heterogeneity and issues of quality in the evidence base at that time. An updated review, focussed on one-to-one peer support, is timely given current policy interest. This study aims to systematically review evidence for the effectiveness of one-to-one peer support interventions for adults using mental health services, and to explore heterogeneity in peer support interventions. Method We searched MEDLINE, PsycINFO, Embase, CINAHL and Cochrane databases from inception until 13 June 2019. Included studies were assessed for risk of bias, and meta-analyses conducted where multiple trials provided usable data. Results Twenty-three studies reporting nineteen trials were eligible, providing data from 3329 participants. While seven trials were of low to moderate risk of bias, incomplete reporting of data in many studies suggested bias in the evidence base. Peer support interventions included peer workers in paraclinical roles (e.g. case manager), providing structured behavioural interventions, or more flexible support for recovery. Meta-analyses were conducted for eleven outcomes, with evidence that one-to-one peer support may have a modest positive impact on self-reported recovery and empowerment. There was no impact on clinical symptoms or service use. Analyses of heterogeneity suggest that peer support might improve social network support. Conclusions One-to-one peer support in mental health services might impact positively on psychosocial outcomes, but is unlikely to improve clinical outcomes. In order to better inform the introduction of peer support into mental health services, improvement of the evidence base requires complete reporting of outcome data, selection of outcomes that relate to intervention mechanisms, exploration of heterogeneity in the implementation of peer support and focused reviews of specific types of one-to-one peer support. Trial registration Prospero identifier: CRD42015025621.

scholarly journals Developing and testing a principle-based fidelity index for peer support in mental health services

2021 ◽  
Author(s):  
S. Gillard ◽  
N. Banach ◽  
E. Barlow ◽  
J. Byrne ◽  
R. Foster ◽  
...  
Keyword(s):  
Mental Health ◽  
Mental Health Services ◽  
Health Services ◽  
Lived Experience ◽  
Peer Support ◽  
Service User ◽  
Service Providers ◽  
Evidence Base ◽  
Clinical Patient ◽  
One To One

Abstract Purpose Evidence suggests that the distinctive relational qualities of peer support—compared to clinical-patient relationships—can be eroded in regulated healthcare environments. Measurement of fidelity in trials of peer support is lacking. This paper reports the development and testing of a fidelity index for one-to-one peer support in mental health services, designed to assess fidelity to principles that characterise the distinctiveness of peer support. Methods A draft index was developed using expert panels of service user researchers and people doing peer support, informed by an evidence-based, peer support principles framework. Two rounds of testing took place in 24 mental health services providing peer support in a range of settings. Fidelity was assessed through interviews with peer workers, their supervisors and people receiving peer support. Responses were tested for spread and internal consistency, independently double rated for inter-rater reliability, with feedback from interviewees and service user researchers used to refine the index. Results A fidelity index for one-to-one peer support in mental health services was produced with good psychometric properties. Fidelity is assessed in four principle-based domains; building trusting relationships based on shared lived experience; reciprocity and mutuality; leadership, choice and control; building strengths and making connections to community. Conclusions The index offers potential to improve the evidence base for peer support in mental health services, enabling future trials to assess fidelity of interventions to peer support principles, and service providers a means of ensuring that peer support retains its distinctive qualities as it is introduced into mental health services.

Functional Somatic Syndromes (FSS) in Children and Adolescents

2020 ◽  
Vol 228 (2) ◽  
pp. 81-92 ◽  
Author(s):  
Maria Kangas ◽  
Karen Hansen Kallesoe ◽  
Charlotte Ulrikka Rask
Keyword(s):  
Mental Health ◽  
Mental Health Services ◽  
Health Services ◽  
Children And Adolescents ◽  
Evidence Base ◽  
Health Complaints ◽  
Functional Somatic Syndromes ◽  
Research Gaps ◽  
Ongoing Research ◽  
Assessment And Treatment

Abstract. Unspecific somatic health complaints and symptoms are common in children and adolescents, varying on a continuum of severity. When persistent and impairing, they are often referred to as functional somatic syndromes (FSS). The overarching objective of this paper is to provide an overview of the pediatric literature in relation to conceptual, assessment, and treatment issues for youth presenting with FSS. Clinical recommendations are outlined including addressing potential feasibility and barrier issues for families presenting to medical and mental health services. Assessment and treatment issues are further discussed in context of two recent psychotherapy trials conducted with children and older age adolescents (aged from 7 to 19 years). Finally, we address ongoing research gaps in this field with view to strengthen the evidence base in the assessment and treatment of youth presenting with FSS.

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