Child-adolescent emergency psychiatry: addressing false positive admissions.

Current literature emphasizes the necessary and increasing role of the emergency department (ED) psychologist. This perspective paper will illustrate that the recent focus on an ED psychologist is necessary, but insufficient. Equally important, is an understanding of when a patient in a potential crisis does not require an ED admission, but rather an assessment that is made prior to the patient going to the ED. The essential role of an outpatient crisis team is vital in differentiating when an ED admission is indicated for a psychiatric crisis (true positive) and when an ED admission is not indicated for a psychiatric crisis (false positive). Evaluating crises prior to ED admissions accomplishes two critical healthcare objectives in a parallel process: 1) accurately assessing the proper level of care needed when a patient reports they are experiencing acute psychiatric symptoms (which may or may not necessitate emergency department level of care, and 2) reducing burden on an already over-extended ED when emergency care is not indicated. Our findings are uniquely drawn from a highly diverse youth patient population in Northern California, United States.

Teachers as first responders: classroom experiences and mental health training needs of Australian schoolteachers.

BACKGROUND: Schoolteachers are often the first to respond when a student presents with a mental health issue in the classroom. This places a burden on schools that impacts school staff, healthcare workers and teachers. More broadly, it places a responsibility on the education system to address students' mental health. This study examines Australian teachers' classroom experiences and the training areas identified by teachers as necessary to manage these issues. METHOD: Interviews were undertaken with 18 in-service teachers between 2020 and 2021 from Catholic, Independent and Public schools. Data were gathered via multiple interviews and analysed using thematic content analysis. RESULTS: The major mental health issues identified by teachers related to mental disorders, depression, anxiety, and a complex range of negative emotional states. Teachers requested training in child and adolescent mental health, counselling skills, early detection and intervention, and training skills to manage the complex relationship with parents and external health and community personnel. Teachers also reported the need to access mental health resources, support and training, which were differentially accessed along socioeconomic status and postcodes. CONCLUSION: The data show that teachers are often placed as first responders when a student has a mental health issue but feel inadequately trained to manage these issues in the classroom. We identified mental health issues presenting in Australian classrooms and documented critical features of mental-health training asked for by teachers in order to address those issues. Given the increasing demands on teachers to address the mental health of children and adolescents, we argue that an urgent review of mental health training for teachers is needed.

Construcción y validación de una escala breve de capacidades de resiliencia en niños(as) respondida por madres, padres y cuidadores (ECR-P/9-12) / Construction and validation of a brief scale of resilience skills for children answered by mothers, fathers, and caregivers (ECR-P/9-12)

Resumen Introducción: La presente investigación tuvo como objetivo elaborar y analizar las propiedades psicométricas de una escala breve de Capacidades de Resiliencia para niños(as) contestada por madres, padres y cuidadores (ECR-P/9-12). Método: Se siguió un diseño instrumental de cuatro fases: (1) construcción de ítems, (2) Validez de contenido, (3) Entrevistas cognitivas y; (4) Análisis de propiedades psicométricas. Resultados: Inicialmente se construyeron 345 preguntas, las que fueron reducidas a ocho a partir de los resultados de las entrevistas cognitivas y la evaluación Inter-jueces. Los ítems fueron aplicados vía online a 267 apoderados de la Región Metropolitana. El análisis factorial mostró indicadores satisfactorios de bondad del ajuste para el modelo de un factor (RMSEA=0,071; CFI=0.980; TLI=974) y una consistencia interna adecuada (α=0,723), quedando la escala constituida finalmente por siete ítems. Conclusión: La ECR-P constituye una herramienta válida y confiable para la evaluación de capacidades de resiliencia en la infancia, constituyendo un aporte para la promoción, prevención e intervención en salud mental.

Introduction: The present research aimed to elaborate and analyze the psychometric properties of a brief scale of Resilience Capacities for children answered by mothers, fathers and caregivers (ECR-P / 9-12). Method: A four-phase instrumental design was followed: (1) item construction, (2) content validity, (3) cognitive interviews and; (4) analysis of psychometric properties. Results: 345 questions were initially constructed, reduced to eight thereafter from the results of the cognitive interviews and the Inter-judge evaluation. The items were applied online to 267 parents and caregivers in the Metropolitan Region. The factor analysis showed satisfactory indicators of goodness of fit for the one-factor model (RMSEA = 0.071; CFI = 0.980; TLI = 974) and adequate internal consistency (α = 0.723), leaving the scale finally made up of seven items. Conclusion: The ECR-P constitutes a valid and reliable tool for the evaluation of resilience capacities in childhood, constituting a contribution for the promotion, prevention and intervention in mental health.

Management of Autism Spectrum Disorder in Italian Units of Child and Adolescent Mental Health: Diagnostic and Referral Pathways.

Overall, the present pilot study provides detailed information on clinical management for Autism Spectrum Disorder (ASD) referral and diagnosis processes that are mandatory for child and adolescent mental health management. The analysis of ASD management, even if carried out on a selected sample of Child and Adolescent Mental Health (CAMH) units, represents a good approximation of how, in Italian outpatient settings, children and adolescents with ASD are recognised and eventually diagnosed. One of the aims of the study was to verify the adherence of Italian CAMH units to international recommendations for ASD referral and diagnosis and whether these processes can be traced using individual chart reports. Overall, the analysis evidenced that Italian CAMH units adopt an acceptable standard for ASD diagnosis, although the reporting of the ASD managing process in the individual chart is not always accurate. Furthermore, data collected suggest some improvements that CAMH units should implement to fill the gap with international recommendations, namely, establishing a multidisciplinary team for diagnosis, improving the assessment of physical and mental conditions by the use of standardised tools, implementing a specific assessment for challenging behaviours that could allow timely and specific planning of intervention.

The effects of cumulative natural disaster exposure on adolescent psychological distress.

Natural disasters are becoming more frequent and destructive due to climate change and have been shown to be associated with a variety of adverse mental health outcomes in children and adolescents. This study utilizes data from three cohort studies of Hurricane Katrina survivors-including low-income mothers from New Orleans; displaced and highly impacted families from Louisiana and Mississippi; and Vietnamese immigrants in New Orleans-to examine the relationship between cumulative natural disaster exposure and adolescent psychological distress approximately 13 years after Katrina. Among 648 respondents with children ages 10-17, 112 (17.2%) reported that their child had exhibited one or more symptoms of psychological distress in the past month. Overall, respondents had experienced an average of 0.6 (SD 1.0) natural disasters following Hurricane Katrina. Each additional natural disaster experienced by the respondent was associated with 1.41 (95% CI 1.05, 1.88) greater odds of his or child experiencing psychological distress in the past month. This relationship was not significantly moderated by any measures of family resilience or vulnerability, nor by race/ethnicity or socioeconomic status, although family functioning, parental coping, and caregiver mental health were independently associated with adolescent psychological distress. The results of this analysis suggest that natural disasters have cumulative, detrimental impacts on adolescent mental health.

The Choice and Partnership Approach to community mental health and addictions services: a realist-informed scoping review protocol.

INTRODUCTION: Early identification and appropriate treatment of child and adolescent mental health disorders can often be hampered by patchwork services with poorly planned or unclear pathways. The Choice and Partnership Approach (CAPA) is an evidence-based transformational model of community (community-based or outpatient) mental health and addictions services for children and adolescents that aims to better match services to needs and to improve timely access to care. CAPA has been variably implemented across jurisdictions but has not been comprehensively evaluated for its impact on system and client outcomes. Our research question is, 'To what degree does CAPA work, for whom and under what circumstances?'. The purpose of this review is twofold: (1) to gain an understanding of the extent and outcomes of the implementation of CAPA in community mental health and addictions services; and (2) to identify the role of context as it influences the implementation of CAPA and resulting client and system outcomes. METHODS AND ANALYSIS: We will conduct a realist-informed scoping review of the literature related to CAPA in either child and adolescent or adult community mental health and addictions services. Relevant studies, reports and documentation will be identified by searching the following online databases: MEDLINE, Embase, CINAHL, PsycINFO, Academic Search Premier, ERIC, Web of Science, Cochrane, Dissertations Abstracts, NCBI Bookshelf, PubMed Central and the Canadian Health Research Collection. The search strategy was developed by a health sciences library scientist and informed by a multidisciplinary team comprising methodological and content knowledge experts. The search will gather evidence from multiple online databases of peer-reviewed literature and grey literature repositories. All articles will be independently assessed for inclusion by pairs of reviewers. The key themes derived from a thematic analysis of extracted data will be presented in a narrative overview. ETHICS AND DISSEMINATION: Research ethics review is not required for this scoping review. The results will be disseminated through meetings with stakeholders (including clients and families, clinicians and decision-makers), conference presentations and peer-reviewed publication. The results of this review will inform an overarching programme of research, policy and quality indicator development to ultimately improve mental health and addictions care and subsequent mental health outcomes for children and adolescents.

Evaluating Training Programs for Primary Care Providers in Child/Adolescent Mental Health in Canada: A Systematic Review.

INTRODUCTION: The need for child/adolescent mental health care in Canada is growing. Primary care can play a key role in filling this gap, yet most providers feel they do not have adequate training. This paper reviews the Canadian literature on capacity building programs in child and adolescent psychiatry for primary care providers, to examine how these programs are being implemented and evaluated to contribute to evidence-based initiatives. METHODS: A systematic literature review of peer-reviewed published articles of capacity building initiatives in child/adolescent mental health care for primary care practitioners that have been implemented in Canada. RESULTS: Sixteen articles were identified that met inclusion criteria. Analysis revealed that capacity building initiatives in Canada are varied but rigorous evaluation methodology is lacking. Primary care providers welcome efforts to increase mental health care capacity and were satisfied with the implementation of most programs. DISCUSSION: Objective conclusions regarding the effectiveness of these programs to increase mental health care capacity is challenging given the evaluation methodology of these studies. CONCLUSION: Rigorous evaluation methods are needed to make evidence-based decisions on ways forward to be able to build child/adolescent mental health care capacity in primary care. Outcome measures need to move beyond self-report to more objective measures, and should expand the measurement of patient outcomes to ensure that these initiative are indeed leading to improved care for families.

INTRODUCTION: Le besoin de soins de santé mentale pour les enfants/adolescents s'accroît au Canada. Les soins de première ligne peuvent jouer un rôle clé pour combler ces besoins croissants, et pourtant, la plupart des prestataires de soins ne croient pas avoir de formation adéquate. Cet article examine la littérature canadienne sur les programmes de renforcement des capacités en pédopsychiatrie pour les prestataires de soins de première ligne, afin d'examiner comment ces programmes sont mis en oeuvre et évalués pour contribuer aux initiatives fondées sur les données probantes. MÉTHODES: Une revue systématique de la littérature et des articles révisés par les pairs publiés sur les initiatives de renforcement des capacités en soins de santé mentale aux enfants/adolescents pour les prestataires de soins de première ligne qui ont été mises en oeuvre au Canada. RÉSULTATS: Seize articles ont été repérés qui satisfaisaient aux critères d'inclusion, L'analyse a révélé que les initiatives de renforcement des capacités au Canada sont variées mais qu'il leur manque une méthodologie d'évaluation rigoureuse. Les prestataires de soins de première ligne acceptent volontiers les initiatives en vue d'accroître leur capacité en matière de soins de santé mentale et étaient satisfaits de la mise en oeuvre de la plupart des programmes. DISCUSSION: Des conclusions objectives sur l'efficacité de ces programmes de renforcement des capacités en soins de santé mentale sont difficiles étant donné la méthodologie d'évaluation de ces études. CONCLUSION: Des méthodes d'évaluation rigoureuses sont nécessaires pour prendre des décisions fondées sur les données probantes à l'égard des moyens de renforcer les capacités des soins de santé mentale pour enfants/adolescents dans les soins de première ligne. Les mesures des résultats doivent aller plus loin que l'auto-déclaration et adopter des mesures plus objectives, et devraient étendre la mesure des résultats des patients pour faire en sorte que ces initiatives mènent vraiment à de meilleurs soins pour les familles.

Parenting for the promotion of adolescent mental health: a scoping review of programmes targeting ethnoculturally diverse families.

A scoping review of the literature on parenting programmes that target the promotion of adolescent mental health was conducted to examine the quality of the studies and unique content of programmes for parents from ethnoculturally diverse communities. PsycINFO and Web of Science were searched in April, 2011 (for all publications prior to that date) and again in August, 2015 (for publications from April, 2011 to August, 2015) using specific keywords and inclusion criteria. A hand search was also conducted. Overall, 107 studies met inclusion criteria for final data extraction and included evaluations of interventions targeted at substance use, early/risky sexual activity and behavioural problems. Eighteen of the 107 studies described programmes targeting parents of adolescents from diverse ethnocultural communities; the quality of these 18 studies was assessed using a marginally modified version of the Downs and Black Checklist (Downs & Black 1998). Their average quality assessment score was 16 out of 28. In addition, two key themes reflected in successful interventions emerged: strengthening parent-adolescent relationship through communication, and importance of community engagement in designing and implementing the intervention. Findings indicate gaps in service delivery to parents of adolescents from ethnoculturally diverse communities; there are a limited number of studies on programmes targeting ethnoculturally diverse parents of adolescents, and the quality of studies that do exist is overall low. Given increasing diversity, more emphasis should be placed on developing and modifying programmes to meet the needs of ethnoculturally diverse communities. More rigorous, standardised efforts should be made to evaluate programmes that do exist.

High school incompletion and childhood maltreatment among street-involved young people in Vancouver, Canada.

While the link between educational attainment and future health and wellness is well understood, little investigation has considered the potential impacts of distinct forms of childhood maltreatment on high school completion. In the present study, the relationship between five categories of childhood maltreatment (physical, emotional, and sexual abuse, and physical and emotional neglect) and completion of high school education were examined using the Childhood Trauma Questionnaire (CTQ). From September 2005 to May 2013, data were collected for the At-Risk Youth Study (ARYS), a cohort of street-involved young people who use illicit drugs in Vancouver, Canada. We used logistic regression to examine the relationship between childhood maltreatment and high school completion, while controlling for a range of potential confounding variables. Specifically, five separate models for each category of maltreatment and two combined models were employed to examine the relative associations between, and cumulative impact of, different forms of childhood maltreatment and educational attainment. Among 974 young people, 737 (76%) reported not completing high school. In separate multivariable analyses physical abuse, emotional abuse, physical neglect, and emotional neglect remained positively and independently associated with an incomplete high school education. In a combined multivariable model with all forms of childhood maltreatment considered together, emotional abuse (adjusted odds ratio = 2.08; 95% confidence interval: 1.51-2.86) was the only form of maltreatment that remained significantly associated with an incomplete high school education. The cumulative impact assessment indicated a moderate dose-dependent trend where the greater the number of different forms of childhood maltreatment the greater the risk of not completing a high school education. These findings point to the need for trauma-informed interventions to improve educational attainment among vulnerable young people, as well as evidence-based prevention programmes, such as the Nurse-Family Partnership, aimed at supporting at-risk families before maltreatment occurs.

Health managers' views on the status of national and decentralized health systems for child and adolescent mental health in Uganda: a qualitative study.

BACKGROUND: Robust health systems are required for the promotion of child and adolescent mental health (CAMH). In low and middle income countries such as Uganda neuropsychiatric illness in childhood and adolescence represent 15-30 % of all loss in disability-adjusted life years. In spite of this burden, service systems in these countries are weak. The objective of our assessment was to explore strengths and weaknesses of CAMH systems at national and district level in Uganda from a management perspective. METHODS: Seven key informant interviews were conducted during July to October 2014 in Kampala and Mbale district, Eastern Uganda representing the national and district level, respectively. The key informants selected were all public officials responsible for supervision of CAMH services at the two levels. The interview guide included the following CAMH domains based on the WHO Assessment Instrument for Mental Health Systems (WHO-AIMS): policy and legislation, financing, service delivery, health workforce, medicines and health information management. Inductive thematic analysis was applied in which the text in data transcripts was reduced to thematic codes. Patterns were then identified in the relations among the codes. RESULTS: Eleven themes emerged from the six domains of enquiry in the WHO-AIMS. A CAMH policy has been drafted to complement the national mental health policy, however district managers did not know about it. All managers at the district level cited inadequate national mental health policies. The existing laws were considered sufficient for the promotion of CAMH, however CAMH financing and services were noted by all as inadequate. CAMH services were noted to be absent at lower health centers and lacked integration with other health sector services. Insufficient CAMH workforce was widely reported, and was noted to affect medicines availability. Lastly, unlike national level managers, lower level managers considered the health management information system as being insufficient for service planning. CONCLUSION: Managers at national and district level agree that most components of the CAMH system in Uganda are weak; but perceptions about CAMH policy and health information systems were divergent.

How to improve the mental health care of children and adolescents in Brazil: actions needed in the public sector / Como aprimorar a assistência à saúde mental de crianças e adolescentes brasileiros: ações recomendadas para o sistema público

INTRODUCTION: Child/adolescent mental health (CAMH) problems are associated with high burden and high costs across the patient's lifetime. Addressing mental health needs early on can be cost effective and improve the future quality of life. OBJECTIVE/METHODS: Analyzing most relevant papers databases and policies, this paper discusses how to best address current gaps in CAMH services and presents strategies for improving access to quality care using existing resources. RESULTS: The data suggest a notable scarcity of health services and providers to treat CAMH problems. Specialized services such as CAPSi (from Portuguese: Psychosocial Community Care Center for Children and Adolescents) are designed to assist severe cases; however, such services are insufficient in number and are unequally distributed. The majority of the population already has good access to primary care and further planning would allow them to become better equipped to address CAMH problems. Psychiatrists are scarce in the public health system, while psychologists and pediatricians are more available; but, additional specialized training in CAMH is recommended to optimize capabilities. Financial and career development incentives could be important drivers to motivate employment-seeking in the public health system. CONCLUSIONS: Although a long-term, comprehensive strategy addressing barriers to quality CAMH care is still necessary, implementation of these strategies could make.

INTRODUÇÃO: Problemas de saúde mental na infância/adolescência (SMIA) trazem diversos prejuízos e geram altos custos. A assistência precoce pode ser custo efetiva, levando a melhor qualidade de vida a longo prazo. OBJETIVOS/MÉTODO: Analisando os artigos mais relevantes, documentos do governo, base de dados e a política nacional, este artigo discute como melhor administrar a atual falta de serviços na área da SMIA e propõe estratégias para maximizar os serviços já existentes. RESULTADOS: Dados apontam evidente falta de serviços e de profissionais para tratar dos problemas de SMIA. Serviços especializados, como o CAPSi (Centro de Atenção Psicossocial Infanto-Juvenil) estão estruturados para assistir casos severos, mas são insuficientes e desigualmente distribuídos. A maioria da população já tem bom acesso às unidades básicas de saúde e um melhor planejamento ajudaria a prepará-las para melhor assistir indivíduos com problemas de SMIA. Psiquiatras são escassos no sistema público, enquanto psicólogos e pediatras estão mais disponíveis; para estes recomenda-se capacitação mais especializada em SMIA. Incentivos financeiros e de carreira motivariam profissionais a procurarem emprego no sistema público de saúde. CONCLUSÕES: Apesar de estratégias complexas e de longo prazo serem necessárias para lidar com as atuais barreiras no campo da SMIA, a implantação de certas propostas simples já poderiam trazer impacto imediato e positivo neste cenário.