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Clinicians working in UK child mental health services are faced with several challenges in providing accurate assessment and diagnosis of attention deficit hyperactivity disorder (ADHD). Within the South London & Maudsley (SLaM) NHS Trust, community Child & Adolescent Mental Health Services (CAMHS) are developing structured pathways for assessing and diagnosing ADHD in young people. To date, these pathways have not been formally evaluated. The main aims of this evaluation are to evaluate all ADHD referrals made to the service in an 18-month period, including the number of completed assessments and proportion of children diagnosed with ADHD; and investigate adherence to the National Institute for Clinical Excellence (NICE) guideline for diagnosing ADHD in children and young people.

Retrospective data analysis was performed using service databases and electronic patient records. Adherence to the clinical guideline was measured using the NICE data collection tool for diagnosing ADHD in children and young people. All completed ADHD assessments were compared to four key recommendation points in the guideline.

Within the time frame, 146 children aged 4-17 years were referred and accepted for an ADHD assessment. Of these, 92 families opted in and were seen for an initial appointment. In total, 36 ADHD assessments were completed, of which 19 children received a diagnosis of ADHD and 17 did not. Aside from structured recording of ADHD symptoms based on ICD-10 criteria (69%) and reporting of functional impairment (75%), adherence to all guidance points was above 90%. The study also found that although a greater proportion of children referred to the service were male and identified as White, these differences narrowed upon receipt of ADHD diagnosis.

Relationship to the existing literature is discussed in relation to the assessment process, demographic characteristics and rates of co-occurrence.

The findings demonstrate that in child mental health services, gold standard practice for diagnosing ADHD should be the adoption of clear, protocol-driven pathways to support appropriate access and treatment for young people and their families.

This article is unique in that it is, to the best of the authors’ knowledge, the first to describe and report clinician-adherence to a structured pathway for diagnosing ADHD in young people within a community CAMHS service in South London.

The purpose of this paper is to describe the evolution of the field of personality disorder since the publication of “Personality disorder: no longer a diagnosis of exclusion” in 2003.

A review of both the academic literature contained within relevant databases alongside manual searches of policy literature and guidance from the key stakeholders was undertaken.

The academic and policy literature concentrates on treating borderline and antisocial personality disorders. It seems unlikely that evidence will resolutely support any one treatment modality over another. Criticism has arisen that comparison between modalities misses inter and intra patient heterogeneity and the measurement of intervention has become conflated with overall service design and the need for robust care pathways. Apparent inconsistency in service availability remains, despite a wealth of evidence demonstrating the availability of cost-effective interventions and the significant inequality of social and health outcomes for this population.

The inclusion of heterogeneous sources required pragmatic compromises in methodological rigour.

This paper charts the recent developments in the field with a wealth of wide-ranging evidence and robust guidance from institutions such as NICE. The policy literature has supported the findings of this evidence but current clinical practice and what patients and carers can expect from services remains at odds. This paper lays bare the disparity between what we know and what is being delivered. The authors argue for the need for greater research into current practice to inform the setting of minimum standards for the treatment of personality disorder.

Over the 30 years, public management and administration scholars have crossed disciplinary boundaries to build a body of scholarship on collaboration for public good, services, and values. The paper aims to discuss these issues.

Public management and administration researchers need to integrate the scholarship on collaboration through systems thinking. How do we define collaboration? How do we distinguish among the categories of collaborative public management (CPM), collaborative governance (CG), and networks? How do systems and institutional context shape collaboration in these categories? Within these categories, what are our units of analysis: individual leadership, organizations, or groups in collaboration processes? How do we apply what we know to practice and design?

The work requires that the authors examine CPM, CG, and networks in their larger and nested institutional contexts to determine how they are related to and shape each other. The Institutional Analysis and Development framework may inform this work. CPM or networks may be nested in CG processes and structures in inter-governmental contexts.

Researchers need more clarity as to the context within which CPM, CG, and networks occur, and in units of analysis and the roles of individual people as managers and as agents of organizations, as distinguished from organizations as constructs.

Scholars need to apply research to practice related to designing systems and structures in which collaboration occurs.

As humankind faces increasingly complex and multifaceted policy problems that cross inter-governmental and international boundaries and require inter-sectoral work, managers and organizations must improve both the design of collaboration in governance and management and mastery of essential skills to participate in collaboration.

CPM, CG, and network research does not sufficiently incorporate or control for institutional context into research design.