A new model to guide identity-focused multidisciplinary rehabilitation for children and young people following acquired brain injury: I-FoRM.

A complexity of biological, psychological, environmental and systemic factors influences a child's adaption after acquired brain injury (ABI), all of which transform as the child matures. Multidisciplinary rehabilitation teams are challenged by balancing family system needs and the child's needs, whilst promoting the child's functional skills in difficult or unappealing tasks. This paper presents the conceptual basis for a model for use in childhood ABI neurorehabilitation to address these challenges. A non-systematic narrative review of literature pertinent to integrated neurorehabilitation of pediatric ABI was conducted. Contemporary models of adult and pediatric psychosocial adaptation involving identity following ABI were reviewed. Key findings were then synthesized with models of pediatric resilience and self-concept development. The resulting model describes a cyclical adaptation process whereby the child learns experientially about their self and their world after ABI. Processes of identity development play a central role - particularly emotive processes of self-evaluation - by influencing the child's motivation for participation, tolerance for challenge, self-regulation and emerging self-awareness. The model directs clinicians to use the psychosocial processes of identity development to enhance the child's willingness and capacity to engage in the daily challenges of rehabilitation. Further systematic development and evaluation of the model is needed.

A Characterisation of Tier 2 Services in Child and Adolescent Mental Health.

UK government initiatives have proposed changes in the provision of child and adolescent mental health services (CAMHS) within the NHS. In response to this, tier 2 services have been created to provide early assessment and intervention and improved access. This study investigated whether these services met the aims compared to traditional generic tier 3 services, using data from a national mapping exercise. The results were consistent with the tier 2 services providing early assessment and intervention and enhanced accessibility of the services compared to tier 3. The implications of these results in relation to service development are discussed.