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Article
Publication date: 4 May 2008

M Garralda, Gillian Rose and Ruth Dawson

The aim of this article is to examine clinical outcomes in a child psychiatry inpatient unit using dedicated measures. Clinicians completed contextual (Paddington…

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Abstract

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.

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Journal of Children's Services, vol. 3 no. 3
Type: Research Article
ISSN: 1746-6660

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Article
Publication date: 11 December 2007

Nicole Hickey, Tami Kramer and M Garralda

The role of the primary mental health worker (PMHW) is relatively new within child and adolescent mental health services (CAMHS). Different organisational structures have…

Abstract

The role of the primary mental health worker (PMHW) is relatively new within child and adolescent mental health services (CAMHS). Different organisational structures have emerged and it is important to study the advantages and disadvantages associated with different PMHW practice models. The current study uses a large, representative sample of PMHWs and operationalises practice models according to the PMHWs' self‐reported location and team alignment thus identifying three models (namely CAMHS outreach, primary care based, and dedicated PMHW team). Comparisons between the models are made in relation to organisation and management, inter‐agency links, and job satisfaction with the aim of exploring the strengths and weaknesses of each model. The results suggest that each model meets the aims of the role and there is greater similarity than dissimilarity between models. However, it also indicates that attention should be paid to improving the working environments and training and development opportunities for all PMHWs irrespective of model, but with particular consideration given to improving the support available to PMHWs working in primary care based models.

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The Journal of Mental Health Training, Education and Practice, vol. 2 no. 4
Type: Research Article
ISSN: 1755-6228

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Book part
Publication date: 21 November 2016

Mattie Tops, Jesús Montero-Marín and Markus Quirin

Engagement, motivation, and persistence are usually associated with positive outcomes. However, too much of it can overtax our psychophysiological system and put it at…

Abstract

Engagement, motivation, and persistence are usually associated with positive outcomes. However, too much of it can overtax our psychophysiological system and put it at risk. On the basis of a neuro-dynamic personality and self-regulation model, we explain the neurobehavioral mechanisms presumably underlying engagement and how engagement, when overtaxing the individual, becomes automatically inhibited for reasons of protection. We explain how different intensities and patterns of engagement may relate to personality traits such as Self-directedness, Conscientiousness, Drive for Reward, and Absorption, which we conceive of as functions or strategies of adaptive neurobehavioral systems. We describe how protective inhibitions and personality traits contribute to phenomena such as disengagement and increased effort-sense in chronic fatigue conditions, which often affect professions involving high socio-emotional interactions. By doing so we adduce evidence on hemispheric asymmetry of motivation, neuromodulation by dopamine, self-determination, task engagement, and physiological disengagement. Not least, we discuss educational implications of our model.

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Recent Developments in Neuroscience Research on Human Motivation
Type: Book
ISBN: 978-1-78635-474-7

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Article
Publication date: 30 November 2012

Elizabeth Tovey, Juan Perez‐Olaizola, Paul Annecke, Jovanka Tolmac and Matthew Hodes

The purpose of this study is to describe the characteristics of severely psychiatrically impaired adolescents requiring day hospital management and the effectiveness of…

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143

Abstract

Purpose

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.

Design/methodology/approach

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.

Findings

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.

Research limitations/implications

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.

Originality/value

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.

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Journal of Children's Services, vol. 7 no. 4
Type: Research Article
ISSN: 1746-6660

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Mental Health Review Journal, vol. 8 no. 2
Type: Research Article
ISSN: 1361-9322

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Article
Publication date: 5 August 2019

Gill Salmon and Michal Tombs

The prevalence of psychiatric disorders in children and young people is increasing, leading to recommendations that medical schools re-consider their curriculum content…

Abstract

Purpose

The prevalence of psychiatric disorders in children and young people is increasing, leading to recommendations that medical schools re-consider their curriculum content and teaching practices for child and adolescent psychiatry (CAP). The purpose of this paper is to seek guidance for undergraduate curriculum development from the wider literature on CAP curriculum content and teaching practices.

Design/methodology/approach

A comprehensive search of the literature was conducted, focussing on studies that examined undergraduate teaching of CAP. In an attempt to establish whether there is an agreed level of curriculum content and teaching practices, literature from all over the world was included.

Findings

Findings suggest that curriculum content and teaching practices are varied, therefore it was difficult to identify best practice upon which recommendations can be made. In addition, despite previous calls for curriculum improvements and expansion of learning objectives, recent studies suggest that there has been little change.

Research limitations/implications

A common theme emerging was the importance of making the CAP curriculum relevant to all future doctors rather than only those who plan to specialise in CAP. Further research to determine what CAP knowledge, skills and attitudes non-psychiatrists think that medical students need to be taught is warranted.

Originality/value

This paper reviewed the literature on undergraduate CAP teaching, highlighting common themes from the wider literature on medical curriculum development to inform how CAP curricula content can be developed to equip future doctors.

Details

The Journal of Mental Health Training, Education and Practice, vol. 14 no. 5
Type: Research Article
ISSN: 1755-6228

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Article
Publication date: 21 June 2013

John Sinclair and Stephanie Holden

This article aims to demonstrate a different approach to identify and assess adolescents experiencing mental health problems, within a school setting. Presently we rely on…

Abstract

Purpose

This article aims to demonstrate a different approach to identify and assess adolescents experiencing mental health problems, within a school setting. Presently we rely on primary care professionals to identify mental health problems and adolescents are often reluctant to access such services. One of the benefits of utilising a mental health surveillance screening tool is to identify mental health problems in adolescents and to implement early intervention.

Design/methodology/approach

A cross‐sectional survey of school pupils from a secondary school was conducted, using the Paediatric Symptom Checklist for Youths (PSCY). The self‐administered questionnaire was completed and identified adolescents were then assessed by the Child and Adolescent Mental Health Services (CAMHS). Out of 247 pupils, 84 per cent of the adolescents completed the questionnaire.

Findings

From the screening tool, 25 per cent were identified for assessment. During their assessment 64 per cent of the young people were given self‐help guides and health promotion advice. The remaining 26 per cent of the adolescents were provided treatment sessions by CAMHS or by Children's Service Worker. Only 10 per cent of these adolescents had been previously seen within the CAMHS.

Research limitations/implications

The PSCY is a useful tool for identifying and assessing adolescents with mental health problems. However, these results are the preliminary findings of a feasibility study. This subject area is a rich source for future research.

Practical implications

Findings from this project will influence wider mental health surveillance of our adolescent population.

Social implications

This approach will also influence future service provision, for such a vulnerable population.

Originality/value

No comparative studies of this nature were found in the United Kingdom.

Details

Mental Health Review Journal, vol. 18 no. 2
Type: Research Article
ISSN: 1361-9322

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Article
Publication date: 1 November 1998

Paul Blenkiron

Examines the knowledge and expectations of patients newly referred to one hospital psychiatric clinic. A total of 57 adults completed a structured questionnaire before…

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458

Abstract

Examines the knowledge and expectations of patients newly referred to one hospital psychiatric clinic. A total of 57 adults completed a structured questionnaire before their first outpatient appointment. The casenotes of all 45 non‐anonymous respondents were reviewed six months later, to discover how their expectations regarding management compared with reality. Forty‐four (77 per cent) referrals expected to see a doctor who dealt with mental health and emotional problems, 41 (72 per cent) anticipated that their problem was treatable, and 41 (72 per cent) wanted, primarily, a chance to talk. Thirty‐four respondents (61 per cent) significantly underestimated their actual appointment duration. Patients received psychotropic medication or were referred to another mental health professional twice as often as they expected. Nevertheless, 25 out of 35 patients (71 per cent) correctly predicted their broad clinical management. Patients are becoming more informed users of mental health care services. Addressing their attitudes and expectations directly at the first outpatient attendance may help in predicting final clinical outcome, and assist in the efficient management of limited resources.

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International Journal of Health Care Quality Assurance, vol. 11 no. 6
Type: Research Article
ISSN: 0952-6862

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Article
Publication date: 6 July 2010

Liam North, Louise Gillard‐Owen, Debbie Bannigan and Chris Robinson

This paper provides an overview of the evidence base for alcohol‐related brain injury (ARBI) and describes how this has been used to develop a pilot programme for the…

Abstract

This paper provides an overview of the evidence base for alcohol‐related brain injury (ARBI) and describes how this has been used to develop a pilot programme for the treatment of ARBI. Key components include: detoxification, assessment, social behaviour network therapy, cognitive rehabilitation and systematic instruction. The programme is being delivered and evaluated in the north of England by Swanswell, a national drug and alcohol treatment charity.

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Advances in Dual Diagnosis, vol. 3 no. 2
Type: Research Article
ISSN: 1757-0972

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Article
Publication date: 20 June 2016

Shelley Marie Norman, Tamsin Ford, William Henley and Robert Goodman

Routine outcome monitoring (ROM) is currently seen as a key driver for service improvement at individual, team and service level. The purpose this paper is to explore the…

Abstract

Purpose

Routine outcome monitoring (ROM) is currently seen as a key driver for service improvement at individual, team and service level. The purpose this paper is to explore the relationships between a patient (parent) reported outcome measure (PROM), a practitioner reported outcome measure, and a patient (parent) reported experience measure (PREM).

Design/methodology/approach

A cohort of 302 primary school-age children was recruited and followed for one year from consecutively accepted referrals to three teams within two English Child and Adolescent Mental Health Services (CAMHS). Parents completed the Strengths and Difficulties Questionnaire (a PROM) and practitioners completed the Clinician Global Assessment Scale at baseline, six and 12 months; parents completed the Experience of Services Questionnaire (a PREM) at six and 12 months.

Findings

PROM and practitioner reported outcome measure data suggested poor clinical outcome in terms of symptoms, impact and levels of functioning but were accompanied by PREM evidence of high levels of satisfaction. There was an unexpectedly low correlation ( < 0.2) between both measures of outcome and satisfaction.

Originality/value

This paper fulfils a need to explore the relationships between different outcome measures to contribute to the understanding of ROM its validity.

Details

Journal of Children's Services, vol. 11 no. 2
Type: Research Article
ISSN: 1746-6660

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