A new consultation, Assessment and reflection model (CARM) used in child and adolescence mental health services (CAMHS).

UK National Guidelines stress the importance of reducing waiting times for mental health assessments and interventions for children. They stress the importance of early help, multidisciplinary working, and collaboration with families regarding treatment plans. We piloted a new assessment model (CARM) within a CAMHS service to: reduce non-attendance rates and subsequently waiting times; increase staff and patient satisfaction; and improve the quality of assessment. All waiting list patients and new referrals over a three-month period were contacted to self-book an hour session to meet two clinicians who utilised collaborative reflection and formulation to produce a care plan (CARM). Results revealed that non-attendance rates dropped from 33% over the month prior to CARM to 7% during CARM. Satisfaction levels were high. Qualitative feedback regarding satisfaction revealed the most common themes was feeling listened to and having the opportunity to listen to staff reflections. The themes of staff satisfaction included 'feeling more supported' and 'feeling safer in their decision making'. All assessments were completed in the one appointment. A formulation-driven care plan was developed and discussed with the family. This approach has the potential to make services more effective, efficient and satisfying for both staff and families.

Preparing midwifery students for traumatic workplace events: Findings from the POPPY (programme for the prevention of posttraumatic stress disorder in midwifery) feasibility study.

BACKGROUND: Midwifery students can experience events on clinical placements that they perceive to be traumatic. There is currently no requirement to provide training about the nature of trauma, normal responses, or the most helpful ways of self-managing these. The POPPY programme, developed for qualified midwives, incorporates educational (the POPPY workshop) and supportive resources to prevent the development of Post-Traumatic Stress Disorder in midwives. As part of the feasibility evaluation of POPPY, the POPPY workshop element was adapted for pre-registration midwifery students (PreR-POPPY). Attention to this issue during pre-registration education could improve student experience and support student retention. OBJECTIVES: To identify students' perspectives on the contents (clarity, understandability, organisation of the workshop, utility, relevance), their understanding of trauma and psychological responses, and confidence in recognising and managing early signs of distress following participation in a PreR-POPPY workshop. Perspectives on preferred timing in their midwifery programmes, and methods of delivery were also sought. DESIGN: In keeping with educational evaluations, anonymous feedback was collected from students. SETTING: Two higher education institutes. PARTICIPANTS: Midwifery undergraduate students on the three year or shortened programme for registered nurses (n = 131), and midwifery educators (n = 5). METHODS: Students participated in the workshop and provided feedback immediately. Midwifery educators participated in a meeting with the researchers to provide feedback. RESULTS: High levels of satisfaction with the contents of the workshop were identified. Ninety-nine percent of students would recommend the workshop to other midwifery students. Provision of the workshop early in midwifery programmes, revisited at later points, was strongly endorsed. Learning outcomes were very positive for understanding trauma/early stress responses, and recognising and managing early responses to trauma. Strong endorsement for the provision of the workshop was received from the midwifery educators. CONCLUSIONS: The pre-registration adapted POPPY workshop should be routinely provided in preregistration midwifery.

A programme for the prevention of post-traumatic stress disorder in midwifery (POPPY): indications of effectiveness from a feasibility study.

Background: Midwives can experience events they perceive as traumatic when providingcare. As a result, some will develop post-traumatic stress disorder (PTSD), with adverse implications for their mental health, the quality of care provided for women and the employing organizations. POPPY (Programme for the prevention of PTSD in midwifery) is a package of educational and supportive resources comprising an educational workshop, information leaflet, peer support and access to trauma-focused clinical psychology intervention. A feasibility study of POPPY implementation was completed. Objective: This study aimed to identify potential impacts of POPPY on midwives' understandingof trauma, their psychological well-being and job satisfaction. Method: POPPY was implemented in one hospital site. Before taking part in the POPPY workshop (T1) midwives (N = 153) completed self-report questionnaires, which measured exposure to work-related trauma, knowledge and confidence of managing trauma responses, professional impacts, symptoms of PTSD, burnout and job satisfaction. Measures were repeated (T2) approximately 6 months after training (n = 91, 62%). Results: Midwives' confidence in recognizing (p = .001) and managing early traumaresponses in themselves and their colleagues significantly improved (both p < .001). There was a trend towards reduced levels of PTSD symptomatology, and fewer midwives reported sub clinical levels of PTSD (from 10% at T1 to 7% at T2). The proportion of midwives reporting high and moderate levels of depersonalization towards care was reduced (33% to 20%) and midwives reported significantly higher levels of job satisfaction at T2 (p < .001). Reductions in self-reported stress-related absenteeism (12% to 5%), long-term changes to clinical allocation (10% to 5%) and considerations about leaving midwifery (34% to 27%) were identified. Conclusions: In conclusion, POPPY  shows very positive potential to improve midwives' mental health and the sensitivity of care they provide, and reduce service disruption and costs for trusts. Large-scale longitudinal evaluation is required.

Antecedentes: las matronas pueden experimentar eventos que perciben como traumáticos cuando proporcionan atención clínica. Como resultado, algunas desarrollarán trastorno de estrés postraumático (TEPT) con efectos adversos para la salud mental de las matronas, la calidad de la atención brindada a las mujeres y las organizaciones en donde trabajan. El POPPY (Programa para la prevención del TEPT en obstetricia) es un conjunto de recursos educativos y de apoyo que comprende un taller educativo, folletos informativos, soporte de pares y acceso a intervenciones psicológicas centradas en el trauma. Se realizó un estudio de factibilidad de la implementación de POPPY.Objetivo: Identificar el impacto de POPPY en la comprensión del trauma por parte de las matronas, su bienestar psicológico y la satisfacción en el trabajo.Método: Se implementó POPPY en un sitio del hospital entre octubre de 2016 y septiembre de 2017. Las matronas (n = 153) empleadas en el sitio anfitrión completaron cuestionarios de auto-reporte antes de participar en el taller POPPY (T1), que midió la exposición al trauma relacionado al trabajo, conocimiento y confianza en el manejo de respuesta al trauma, impacto profesional, síntomas de TEPT, agotamiento y satisfacción en el trabajo. Las mediciones se repitieron (T2) aproximadamente 6 meses después del entrenamiento (n = 91, 62%).Resultados: la confianza de las matronas en el reconocimiento (p = .001) y el manejo de las respuestas tempranas al trauma en sí mismas (p <.001) y colegas mejoró significativamente (p <.001). Hubo una tendencia en la reducción de los niveles de sintomatología de TEPT, y menos matronas informaron niveles subclínicos de TEPT (10% a 7%). La proporción de matronas que informaron niveles altos y moderados de despersonalización hacia la atención se redujo (33% a 20%) y las matronas informaron niveles significativamente más altos de satisfacción laboral en T2 (p <.001). Se identificaron: reducciones en el ausentismo auto-reportado relacionado con el estrés (12% a 5%), cambios a largo plazo en la asignación clínica (10% a 5%) y razones para dejar la profesión de matrona (34% a 27%).Conclusiones: los hallazgos resaltan un potencial muy positivo del programa POPPY para mejorar la salud mental de las matronas, la sensibilidad de la atención que brindan y reducir la interrupción del servicio y los costos para los proveedores de servicios. Se requiere una evaluación a gran escala.

Pre-surgical mapping of eloquent cortex for paediatric epilepsy surgery candidates: Evidence from a review of advanced functional neuroimaging.

PURPOSE: A review of all published evidence for mapping eloquent (motor, language and memory) cortex using advanced functional neuroimaging (functional magnetic resonance imaging [fMRI] and magnetoencephalography [MEG]) for paediatric epilepsy surgery candidates has not been conducted previously. Research in this area has predominantly been in adult populations and applicability of these techniques to paediatric populations is less established. METHODS: A review was performed using an advanced systematic search and retrieval of all published papers examining the use of functional neuroimaging for paediatric epilepsy surgery candidates. RESULTS: Of the 2724 papers retrieved, 34 met the inclusion criteria. Total paediatric participants identified were 353 with an age range of 5 months-19 years. Sample sizes and comparisons with alternative investigations to validate techniques are small and variable paradigms are used. Sensitivity 0.72 (95% CI 0.52-0.86) and specificity 0.60 (95% CI 0.35-0.92) values with a Positive Predictive Value of 74% (95% CI 61-87) and a Negative Predictive Value of 65% (95% CI 52-78) for fMRI language lateralisation with validation, were obtained. Retrieved studies indicate evidence that both fMRI and MEG are able to provide information lateralising and localising motor and language functions. CONCLUSIONS: A striking finding of the review is the paucity of studies (n=34) focusing on the paediatric epilepsy surgery population. For children, it remains unclear which language and memory paradigms produce optimal activation and how these should be quantified in a statistically robust manner. Consensus needs to be achieved for statistical analyses and the uniformity and yield of language, motor and memory paradigms. Larger scale studies are required to produce patient series data which clinicians may refer to interpret results objectively. If functional imaging techniques are to be the viable alternative for pre-surgical mapping of eloquent cortex for children, paradigms and analyses demonstrating concordance with independent measures must be developed.