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The aim of this article is to examine clinical outcomes in a child psychiatry inpatient unit using dedicated measures. Clinicians completed contextual (Paddington Complexity Scale - PCS) and clinical change (Health of the Nation Outcome Scales for Children and Adolescents - HoNOSCA) questionnaires on admission and discharge for consecutive admissions to the unit between 1999 and 2007 (n=167). Mean changes in HoNOSCA scores were analysed, and the predictors of HoNOSCA mean change were assessed using regression analysis. The results showed that the mean length of stay at the unit was 5.6 months (SD 3.1). PCS ratings identified high total, clinical, and environmental complexity scores. HoNOSCA ratings indicated high levels of psychological problems on admission and significant improvement at discharge (mean change 7.7 (SD 6.7)). Greater positive change was associated with higher initial HoNOSCA scores, diagnoses other than conduct disorder and schizophrenia, and a facilitative parental attitude. The authors conclude that the systematic use of standardised outcome measures in child psychiatric inpatient units is useful to document clinical features, complexity and clinical change.

Government guidelines state that health services must measure outcomes for patients. However, there is only limited evidence on outcome measures for children with learning disabilities. This paper reports on a study designed to investigate the suitability and effectiveness of four outcome measures (Health of the Nation Outcome Scales for Children and Adolescents ‐ HoNOSCA, Children's Global Assessment Scale ‐ C‐GAS, Strengths and Difficulties Questionnaire ‐ SDQ, and Commission for Health Improvement Experience of Service questionnaire ‐ CHI) for a community team working with children with learning disabilities. The paper highlights the difficulties in capturing the impact of service intervention in a multidisciplinary community setting. The implications of the research for clinical practice are discussed.

The purpose of this study is to describe the characteristics of severely psychiatrically impaired adolescents requiring day hospital management and the effectiveness of the service using standardised outcome measures.

The data was collected on adolescents aged 13‐17 years in two London boroughs, attending the day service over a period of one year. Outcome measures were HoNOSCA, CGAS, SDQ and qualitative data from feedback forms from adolescents and parents.

The adolescents (n=22) had varied disorders, but mainly depression, (n=9) and psychosis (n=4). HoNOSCA score on admission was mean 18.14 (SD 3.78) but by discharge it had reduced to mean 15.39 (SD 7.31) (p=0.07), and CGAS reduced from initial mean score of 43.83 (SD 9.90) to 53.17 (SD 12.04) (p=0.003). Attendance for 19 (86 per cent) adolescents was for less than six months. Following discharge 14 (64 per cent) returned to education or employment. Adolescents and their carers reported high levels of satisfaction. The findings indicate substantial improvement and satisfaction with the service. The size of the improvement in outcome scores and the consistency across the HoNOSCA and CGAS associated with high service satisfaction also suggest that the data is reliable.

The small size of the sample and loss of data made it difficult to extrapolate from the results to other groups of impaired adolescents. There was no control group in the study and therefore it was not possible to demonstrate whether the improvement was due to spontaneous changes over time, Tier 3 CAMHS input or the attendance at the day service. It is difficult to demonstrate what proportion of adolescents who were admitted to the day service would have required a Tier 4 in patient admission had the service not been available. A larger study using a more robust design involving randomisation to the day‐service or in‐patient service would provide important comparative data regarding the service benefits.

Currently there is little provision for severely psychiatrically impaired adolescents who require a day treatment programme. Day patient programmes appear to offer a useful and accessible treatment method. The service is much cheaper than an in‐patient service, and may also reduce the demands for or duration of inpatient admission. Unfortunately the service did not obtain continuation funding in view of NHS funding cuts, rather than dissatisfaction by local commissioners, and so needed to close. The data presented here can hopefully be used to support the case for child and adolescent psychiatric day programmes.

Dialectical behaviour therapy (DBT) aims to reduce emotional dysregulation and engagement in less adaptive behaviours for adults with mixed disorders of conduct and emotions (MDCE). However, there is limited evidence available for the effectiveness of DBT skills training for adolescents with MDCE who are resident within a secure impatient setting. The paper aims to discuss these issues.

A retrospective study investigated changes in aggressive and self-injurious behaviours in 22 adolescents within a secure inpatient mental health setting with MDCE who had completed one cycle of DBT skills training. Changes in symptomatic problems, behavioural and social impairment were also investigated in 17 of the 22 participants who completed the DBT skills training cycle.

There were statistically significant decreases in the frequencies of engagement in total aggressive and deliberate self-harm behaviours after the DBT skills training cycle. There was a significant improvement in symptomatic and behavioural impairment, but not in social impairment.

The findings of this study suggest that DBT skills training may be beneficial for behavioural and symptomatic outcomes in adolescent inpatients with MDCE.

This study provides preliminary evidence for the effectiveness of DBT skills training for adolescents with MDCE within a secure inpatient setting. Additional studies are required to investigate the clinical benefits of specific aspects of DBT for individual patients.

The first NHS forensic low secure unit for adolescents, the Westwood centre, opened in 2004. This paper seeks to focus on service utilisation and initial outcomes for the young people admitted in the first 45 months compared with young people accessing a neighbouring open adolescent unit.

In order to understand service utilisation and initial outcomes, the clinical profiles of young people admitted in the first 45 months were evaluated. This included demographics, locality, admission status, length of stay, medication use, presenting problem, diagnosis, previous and discharge destination. The profiles of young people accessing the low secure unit were then compared with young people accessing a neighbouring open adolescent unit. Clinical profiles were ascertained from available healthcare records and service data. These were inspected and analysed using descriptive statistics.

Thirty (54 per cent) of the 56 Westwood young people were male, the mean age at admission was 16.3 years and mean length of stay was 202 days. Twenty‐five (44 per cent) young people had a discharge diagnosis related to psychosis, the remainder having primary problems relating to emotional and/or conduct problems. 26 (47 per cent) were discharged to another hospital setting and 20 (35 per cent) returned to their home of origin. Young people accessing the low secure unit were significantly older at admission and there was a trend for a higher proportion of females to be admitted to the open setting. In addition, the low secure unit had a greater proportion of young people with psychotic disorders and longer lengths of stay. Case examples illustrate a pilot of initial outcomes.

There were time differences in comparison of low secure and open unit and retrospective use of health care records.

Clinical profiling is useful as a basis to consider clinical outcomes, pathways, utilization of a service, service/training needs and development. Comparisons between inpatient units provide further evidence to the areas above and help dispel myths that may otherwise guide decisions, e.g. about which diagnoses or gender affecting length of stay. Most young people progress positively from the low secure service onto open or community settings. Improving future outcomes for young people include such as through diversion from custody, length of admission, reduced symptoms/risks and planned progress to suitable community placements or home.

The paper provides a clinical profile of young people accessing a low secure setting in comparison to an open unit. This has relevance to other secure and inpatient adolescent units and is important in considering pathways and outcomes.

Ethical concerns about the use of the Mental Health Act (MHA) have led to calls for developmental disorders to be removed from the list of mental disorders for which individuals can be detained. In parallel, there are long-standing concerns of ethnic disparity in the application of the MHA. Nonetheless, the impact of the intersections of developmental disorder diagnosis, adolescence and ethnicity on the application of the MHA is unknown. This study aims to explore ethnic differences in MHA sections and the factors accounting for this, in an adolescent inpatient developmental disorder service.

File reviews were conducted to explore differences in MHA status, as well as demographic, clinical and risk factors that may account for this, between 39 white British and ethnic minority adolescents detained to a specialist inpatient developmental disorder service.

Consistent with adult literature, adolescents of an ethnic minority were overrepresented in the sample and were significantly more likely to be detained on Part III or “forensic” sections of the MHA than White British counterparts, with five times greater risk. Analyses revealed no significant differences between ethnic minority and white British participants on demographic variables, clinical needs, risk behaviours, risk measures nor application of restrictive practices and safeguarding procedures.

National audits exploring patterns of detention under the MHA across adolescent developmental disorder populations need to include analysis of intersections to ensure that the MHA is used as a means of last resort and in an equitable manner.

To the best of the authors’ knowledge, this paper is the first comprehensive exploration of the impact of ethnicity on detention patterns in ethnic minority and White British populations.

Children and young people with an intellectual disability (referred to in this article as young people) have a higher incidence of mental illness and challenging behaviour than individuals without cognitive impairment. Inpatient assessment and treatment in a learning disability‐specific provision rather than mainstream inpatient child and adolescent mental health services (CAMHS) is most beneficial for those young people who experience a more severe intellectual disability or whose presenting complaint is challenging behaviour not associated with a co‐morbid mental illness. Assessment and treatment of this complex group of young people can only be successful if the services which manage them have access to a highly experienced and comprehensive multidisciplinary team. Admission is only worthwhile if recommendations that arise from the assessment can be transferred to the community and those involved in supporting the young person are motivated to work in collaboration with the inpatient team.

Playfield Institute is a unique partnership between child and adolescent mental health services (CAMHS) and public health. The institute model is an innovative response to the national challenge to mainstream mental health. Its focus is to build the capacity of frontline workers (otherwise known as the children's workforce eg. school nurses, social workers, teachers, foster carers etc.) to promote the mental health of children and young people. It works by providing a multi‐agency forum for sharing information and developing practical skills on how to help children flourish. It also encourages reflection on practice and undertakes research that has a direct impact on the development of training and practice. To date, the Institute has achieved the following main outcomes: the facilitation of a successful training programme, the development of a well used, effective, online resource and the co‐ordination of a range of applied research projects. This paper discusses why the Institute was set up, what it is, what it has achieved and how the model is sustainable.

Following a description of the Haven Project: a school based Child and Adolescent Mental Health Service (CAMHS) for refugee children in Liverpool, this paper aims to raise awareness of a multiagency model for replication across community mental health services.

Using semi‐structured interviews with school head teachers and outcome measures of group therapeutic sessions, a short service review has been conducted, set against background literature, identifying refugee statistics and highlighting mental health policy imperatives that advocate multi‐agency working.

The findings illustrate that refugee children are more likely and prefer to access a school based mental health service than a CAMH clinic. Links between schools and CAMHS facilitate mutual understanding of different agencies working in the interests of all children and, using outcome measures and quotes, the evidence indicates that the service achieves its aim: improvement in refugee children's mental health.

Limitations to the findings are recognised in the small numbers presented, methodological restrictions, and the lack of routinely collated statistics on refugee populations.

Combining description and evaluation, this paper appraises service design and delivery methods to present an overview with policy and practice implications; addressing key mental health and public health policy priorities; and exemplifying multiagency collaboration between the health and education sector to meet the needs of an often invisible and neglected group: refugee children. It is anticipated this information will inform future service design, meeting policy priorities and the needs of service users as an accessible and responsive way to deliver CAMHS to vulnerable populations.