Therapeutic relationships within child and adolescent mental health inpatient services: A qualitative exploration of the experiences of young people, family members and nursing staff

Child and adolescent mental health services (CAMHS), especially inpatient units, have arguably never been more in demand and yet more in need of reform. Progress in psychotherapy and more broadly in mental health care is strongly predicted by the therapeutic relationship between professional and service user. This link is particularly pertinent in child and adolescent mental health inpatient services where relationships are especially complex and difficult to develop and maintain. This article describes a qualitative exploration of the lived experienced of 24 participants (8 young people, 8 family members/carers and 8 nursing staff) within inpatient CAMHS across four sites in the UK. We interviewed participants individually and analysed the transcripts using thematic analysis within a critical realist framework. We synthesised data across groups and present six themes, encapsulating the intricacies and impact of therapeutic relationships; their development and maintenance: Therapeutic relationships are the treatment, Cultivating connection, Knowledge is power, Being human, The dance, and It’s tough for all of us in here. We hope these findings can be used to improve quality of care by providing a blueprint for policy, training, systemic structures and staff support.

Adopting the Concept of ‘Ba' and the ‘SECI' Model in Developing Person-Centered Practices in Child and Adolescent Mental Health Services

The concept of knowledge is divided into explicit and tacit knowledge; explicit knowledge refers to the knowledge that can be articulated, written and stored, while tacit knowledge refers to personal experiences, values, beliefs and emotions of an individual. By Nonaka's theory, explicit and tacit knowledge do not lie separately but interact together by interactions and relationships between human beings. Thus, the SECI model is based on the assumption that knowledge is created through the social interaction of tacit and explicit knowledge; known as knowledge conversion. The SECI model is based upon four modes of knowledge conversion; socialization, externalization, combination and internalization. 'Ba' is considered to be a shared platform for knowledge creation. 'Ba' is a shared space, be it physical, mental or a combination of both that serves as a foundation of knowledge creation. Ba involves sharing of tacit knowledge i.e. emotions, feelings, experiences and mental images. It also involves the formation of a collective relationship which is open to the sharing of practices, values, processes and culture. This concept focuses mainly on the individual as a person who holds the knowledge rather than just on the knowledge itself. It aims to create a common space to bring people together where they can dialogue to share and create knowledge. As in the relationships formed in person-centered practices, relationships formed in Ba are based on not just the sharing of objective knowledge but also on sharing values, beliefs, and emotions. It also reflects the formation of a person-centered environment as a basis for person-centered research where healthful relationships with the participants are formed. Furthermore, Ba will aid in creating a sense of connectiveness and dialogue, thus focusing on the idea that the development of new practices is done with others rather than to others. In this article we will discuss how these Eastern concepts can be adapted and used to develop person-centered practices within child and adolescent mental health services, specifically related to rehabilitation and recovery. The concepts of personhood will be discussed, followed by a reflection on current practices adopted when working with children and adolescents.

Feasibility of Establishing a Core Set of Sexual, Reproductive, Maternal, Newborn, Child, and Adolescent Health Indicators in Humanitarian Settings: Results from a Multi-Methods Assessment in the Democratic Republic of Congo

Background: Reliable and rigorously collected sexual, reproductive, maternal, newborn, child, and adolescent health (SRMNCAH) data in humanitarian settings are often sparse and variable in quality across different humanitarian settings. To address this gap in quality data, the World Health Organization (WHO) developed a core set of indicators for monitoring and evaluating SRMNCAH services and outcomes and assessed their feasibility in four countries, including the Democratic Republic of Congo (DRC) with the goal of aggregating information from global consultations and field-level assessments to reach consensus on a set of core SRMNCAH indicators among WHO partners. Methods: The feasibility assessment in DRC focused on the following constructs: relevance/usefulness, feasibility of measurement, systems and resources, and ethical issues. The multi-methods assessment included five components; a desk review, key informant interviews, focus group discussions, facility assessments, and observational sessions. Results: The findings suggest that there is widespread support among stakeholders for developing a standardized core list of SRMNCAH indicators to be collected among all humanitarian actors in DRC. There are numerous resources and data collection systems that could be leveraged, built upon, and improved to ensure the feasibility of collecting this proposed set of indicators. However, the data collection load requested from donors, the national government, international and UN agencies, coordination/cluster systems must be better harmonized, standardized, and less burdensome. Conclusions: Despite stakeholder support in developing a core set of indicators, this would only be useful if it has the buy-in from the international community. Greater harmonization and coordination, alongside increased resource allocation, would improve data collection efforts and allow stakeholders to meet indicators’ reporting requirements.