Practical Crisis Management for Parents and Clinicians: Adolescent Suicidal, Aggressive, Elopement Behaviours: Intensive Treatment Settings.

OBJECTIVE: In the many guidelines, recommendations and strategies for crisis management of suicide-related behaviours, aggression/vandalism and elopement in adolescents, immediately usable and specifically detailed descriptions and rationales of the strategies, especially for parents, are noticeably absent. This paper describes a feasibility project to develop one overall detailed strategy with specific adaptations for each of the three crises for adolescents in intensive services. It is a contribution to the discussion and joint service/parent management of these crises. METHOD: The factors to consider and the development of the strategy and PARENT GUIDE are described. Examples are provided. While the main work was done by the psychiatrist and staff of a day treatment service many other colleagues and families contributed over the seven years. The accompanying PARENT GUIDE is a necessary, separate and available document. RESULTS: Since the purpose was to develop and evolve the strategy, it did not lend itself to a clear research outcome. However, careful estimates using the approximately 30 adolescents (of about 350 adolescents) for whom the strategy was used showed: no deaths, assault and vandalism stopped and elopement was managed. Parents regained skills, hope and improved relationships with their adolescents. They developed the confidence, specific knowledge and skills to manage for the future. CONCLUSIONS: The successful development and evolution of the strategy demonstrated feasibility of the concept. The hope is that such strategies contribute to the advancement of patient care, the discussion in the literature and provide the basis for future research.

OBJECTIF: Dans de nombreuses lignes directrices, les recommandations et stratégies de gestion de crise pour des comportements liés au suicide, à l'agressivité/vandalisme et à la fugue chez les adolescents, les descriptions immédiatement utilisables et spécifiquement détaillées et les justifications des stratégies, surtout pour les parents, sont nettement absentes. Cet article décrit un projet de faisabilité afin d'élaborer une stratégie générale détaillée comportant des adaptations spécifiques à chacune des trois crises pour les adolescents dans des services intensifs. C'est une contribution à la discussion et à la gestion conjointe service/parent de ces crises. MÉTHODE: Les facteurs à prendre en compte et l'élaboration de la stratégie et du GUIDE DES PARENTS sont décrits. Des exemples sont fournis. Bien que la majeure partie du travail ait été effectuée par le psychiatre et le personnel d'un service de traitement de jour, nombre d'autres collègues et familles ont contribué au fil des sept années. Le GUIDE DES PARENTS annexe est un document nécessaire, distinct et disponible. RÉSULTATS: Puisque le but était d'élaborer et de faire évoluer la stratégie, il ne se prêtait pas à un résultat de recherche défini. Toutefois, des estimations prudentes obtenues à l'aide des quelque 30 adolescents (sur environ 350 adolescents) chez qui la stratégie a été utilisée ont démontré : aucun décès, arrêt des agressions et du vandalisme, et gestion des fugues. Les parents ont retrouvé leurs compétences, l'espoir et ont amélioré leurs relations avec leurs adolescents. Ils ont acquis la confiance, les connaissances et les compétences spécifiques pour la gestion future. CONCLUSIONS: L'élaboration et l'évolution réussies de la stratégie ont démontré la faisabilité du concept. L'espoir est que ces stratégies contribuent au progrès des soins des patients et à la discussion de la littérature, et qu'elles constituent une base pour la future recherche.

Government monitoring of the mental health of children in Canada: five surveys (part I).

OBJECTIVE: Canadian governments spend billions of dollars yearly on programmatic interventions, intended to improve the mental health of children, without recommended monitoring of children's mental health. The Canadian Academy of Child and Adolescent Psychiatry monitored governments' progress in producing reports. METHOD: Five evolving surveys were done during 2002, 2004, 2005, 2006 and 2008. Initially, progress was monitored then later surveys examined challenges that inhibited monitoring, the need for a national strategy, an indicator framework and an agency to do the monitoring and the role of non-government organizations. The 2008 survey requested the three most important indicators governments desired, and created clarity in the definition of monitoring reports in contents, criteria, qualities of indicators and potential names. For comparison purposes, a Partnership Model to survey populations was evaluated. RESULTS: Over five surveys, 13 of 14 governments affirmed the desire for monitoring and 64 publications were reviewed and categorized. No reports met criteria for 'monitoring reports'. The Partnership Model was used successfully in 11 Provincial-Territorial governments. CONCLUSIONS: It was reassuring that governments supported monitoring and were producing reports. The Partnership Model may offer a suitable alternative for governments. Results of 2006 and 2008, discussion, conclusions and references are in Part II.

Government Monitoring of the Mental Health of Children in Canada: Five Surveys (Part II).

OBJECTIVE: Canadian governments produced 64 reports containing data about the mental health of children but no reports could adequately be called monitoring reports. Surveys sought to clarify definitions, challenges and processes that could help lead to regular reports. METHOD: (Details in Part I). The 2006 survey clarified government current data use and future need, challenges to producing reports and the role of NGOs. The 2008 survey clarified the definition of reports, governments' most desired indicators, and national factors. RESULTS: Governments wanted the data for policy making, program construction, priority setting and resource allocation. The most challenging difficulties were governments themselves: coordinating among departments, lack of funding, lack of an agency and lowered priority. Governments most wanted indicators of child functioning, population health and early identification. Reports needed to meet specific criteria for contents, indicator qualities, population characteristics and regularity. CONCLUSIONS: Governments wanted a national strategy, national framework and agreement on a measuring agency. Good general agreement existed about reporting criteria. A partnership model may lead to quicker results given the difficulties within governments. NGOs and others need to continue collaborative advocacy. Monitoring is one of two steps that could help turn collections of services into self-regulating systems.