Gender differences in adolescents attending a drug and alcohol withdrawal service.

INTRODUCTION AND AIMS: Gender differences have been reported in adult substance users, but little research has examined gender differences in adolescents presenting to treatment services. This study aimed to explore gender differences in adolescents presenting to a withdrawal service. DESIGN AND METHODS: All presentations to a withdrawal service between March 2000 and September 2004 were identified. For each presentation, the following information was extracted from clinical databases: sociodemographics, drug use, risk-taking behaviour, mental health symptoms, reasons and context of drug use. Significant gender differences identified at bivariate analysis were then incorporated into multivariate models exploring predictors of heroin use, cannabis use and sharing injecting equipment. RESULTS: A total of 262 young people were admitted during the study period (53% male, mean age 16.8 years; SD 1.13). Bivariate analysis indicated that girls were more likely to report: being homeless, using a greater number of substances, using heroin and amphetamines, higher rates of injecting, sharing injecting equipment and using with a partner. Multivariate analysis identified that being female was an independent predictor of heroin use and that being male was an independent predictor of cannabis use. Significant predictors of sharing injecting equipment were using with a partner and current use of heroin; the effect of gender was not significant after controlling for other factors. DISCUSSION AND CONCLUSIONS: Our findings indicate that male and female adolescents presenting to a withdrawal treatment service exhibit differences in substance use characteristics. Future research should examine the role of gender in determining optimal treatment approaches in substance-using adolescents.

Towards a developmental framework of consumer and carer participation in child and adolescent mental health services.

OBJECTIVE: This paper examines the concept of consumer participation in the context of developmental changes in parent/child relationships and associated differences in the utilization of child and adolescent mental health services. METHOD: Existing definitions and characteristics of mental health service delivery for children and young people are examined to answer the question,"Who is the consumer in the context of clinical services for young clients and their parents, and does this change with the child or young person's developmental stage?". RESULTS: As children, young people and parents utilize services in this area of mental health, the roles of consumer and carer need redefinition to accommodate both young clients and parents as consumers, and parents also as carers. CONCLUSION: The proposed framework addresses the changing roles of parents and young clients from infancy to early adulthood to guide consumer and carer participation strategies. If child and adolescent mental health services are to apply a developmental perspective and engage both young clients and parents as 'consumers', they need to address challenges related to the differences in expectations and capacities of young clients and parents, to the complexity associated with dual roles, and to promoting meaningful participation.

Multidisciplinary perspectives on core networking skills. A study of skills: and associated training needs, for professionals working in managed clinical networks.

Possessing a wide mix of non-clinical competences is important for professionals involved in managed clinical networks (MCNs). Skills that stand out are related to interpersonal issues, problem solving, decision-making, and managing change. Interprofessional and interorganizational collaboration is important in health care generally and is not confined to MCNs. Skills are likely to have relevance in wider contexts. Training needs identified for professionals in MCNs relate to skills associated with working in challenging situations, including: 'managing change,' 'conflict resolution,' and 'negotiation.' Limited generalizations about profession-specific skills and training needs can be made. However, it is more appropriate to identify skills needed for the specific role(s) an individual is asked to perform, and to investigate if there are performance gaps between skills and competencies.

Current delivery of infant mental health services: are infant mental health needs being met?

OBJECTIVE: To identify services supporting the well-being of infants and their families in an area of South Brisbane, Australia, highlight problems of accessing these services and recommend strategies to make them more readily available. METHOD: Semistructured interviews were conducted with staff from 18 service providers offering antenatal services, or programmes primarily focused on children under the age of 2 years and/or their families. The interview aimed to identify the precise nature of the services offered, problems encountered in providing those services, perceived gaps in services and potential strategies for improvement. RESULTS: Services were diverse, provided by a range of different professionals, in varying locations (home, community, hospital) and with funding from various sources. The major findings were: (i) the fragmentation of services, lack of communication between them, and lack of continuity in services from one stage of family formation to another; (ii) the shortage of services working with the parents and infant together; and (iii) the difficulty of providing services for some at-risk populations. CONCLUSIONS: Recommendations included: (i) maintaining a range of different services networked through a centralized resource/referral centre; (ii) expanding joint mother-infant services and providing training for such services; and (iii) supporting outreach services for difficult to engage populations.

Social networks of people with dual diagnosis: the quantity and quality of relationships at different stages of substance use treatment.

This study compares the social networks, perceived levels of social support, and satisfaction with this support, for people with serious mental illnesses and comorbid problematic use of alcohol and other drugs who are at different stages of substance use recovery. Participants in the late stage of recovery were more likely to perceive greater social support from their non substance-using social contacts than participants in the early stage. This social support was more likely to be from professionals than other non-substance-using contacts in their networks. The support from professionals is discussed in relation to engagement in integrated dual diagnosis interventions.