Evidence-based Medicine and Child Mental Health Services

There is increased focus on using research evidence to guide clinical practice in the provision of child mental health services, to allocate resources and to make policy decisions. Emphasis has been placed on randomised controlled trials, which are clearly vital. However, given the complexity of children's lives and the multiple systems relevant to their care, it is important to consider alternative research designs and to think creatively about outcomes. In the context of difficulties with random allocation a number of quasi-experimental designs are described that may more closely reflect actual clinical work. In the context of ecological theory, the importance of taking a systems level approach to evaluation is highlighted, with examples from the US. Finally, the ways in which qualitative outcomes measures can be used to sensitively describe the effects of treatment are outlined, and their potential for giving voice to children and families as consumers of mental health services. These suggestions aim to lessen the tension between the requirements of the scientific investigations of treatment effectiveness and the realities of clinicians' daily experiences.     

Engaging with Parents in Child and Adolescent Mental Health Services

This paper asks the question: How can child and adolescent mental health clinicians constructively engage parents as a resource in the young person's treatment? It draws from qualitative research data that explore parents' experience of their involvement in their adolescent's mental health treatment program. The paper especially focuses on challenges for clinicians in engaging with parents as part of the treatment program for young people. Clinicians' input about their perceptions of interacting with parents is utilised alongside parents' experiences of their involvement in clinical processes. The clinician data revealed key challenges were managing their reactions to parent defensiveness; broadening the focus from just alleviating symptoms in the young person; not taking sides with the young person; and resisting becoming an expert instructor. The paper discusses Murray Bowen's original family research about engaging parents in treatment with the symptom bearer and addresses how clinicians can build a positive alliance with parents that avoids blame while constructively opening exploration of the family relationship process as part of a collaborative approach.     

Queering Child and Adolescent Mental Health Services: The Subversion of Heteronormativity in Practice

This article explores the exercise of heterosexist‐infused power relations within a Child and Adolescent Mental Health Services (CAMHS) inpatient unit in the UK. The ways in which heterosexism may wield its power within CAMHS in conjunction with the support of sexism, adultism, classism and sanism are discussed. That is, this article contributes to the understanding and subverting of heteronormativity in practice. With this focus in mind, other forms of intersecting oppressions are detailed to highlight the role they play in both controlling young people and teaching them about the workings of patriarchy and social norms. The aim of the article is to contribute to the disruption of the heteronormativity inherent in the arrangements within CAMHS and the dominant normative practice that produces multiple subjectivities in this setting.     

Caregivers' Endorsement of Barriers to Mental Health Services for Children and Youth in Child Welfare

The purpose of this study was to examine the three most common types of caregivers in the child welfare system (birth parents, relative caregivers, and foster parents), an active child welfare case, caregivers' endorsement of barriers to mental health services and mental health service use by caregivers for the children under their care. The sample consisted of 430 dyads (caregivers and their children). Results indicate that an active child welfare case, provider characteristics, and accessibility of services predicted mental health service use for children. Implications for the child welfare and mental health systems are discussed.     

College Time: Implications for Student Mental Health Services

Abstract

Time conditions on campus are in many ways extreme and contribute to the distinctiveness and stress of the college or university experience. This paper studies college time by examining the variables of duration, change, and degree of structure across the perspectives of the overall college career, the course of a single semester, and day to day student life. The most salient features that are identified are the interruptions in the college experience caused by vacations and leaves from campus, the extent and pace of change both over the college career and over the semester, and the lack of a set time structure in daily student life. These and other time features, it is proposed, have a dual effect on student mental health services, influencing the content and timing of students' issues in psychotherapy and the nature of the psychotherapy that mental health offices provide. In light of the special features of college time, recommendations are offered regarding waiting lists, duration of therapy, distribution of sessions, scheduling of sessions, and time-based evaluations and interventions.

“Primary Plague Pneumonia Contracted from a Domestic Cat at South Lake Tahoe, Calif,” S. Benson Werner, et al. Primary plague pneumonia occurred in a 47-year-old South Lake Tahoe woman shortly after face-to-face exposure to her plague pneumonia-infected cat. Both died. Field investigation revealed a recent plague epizootic in squirrels and chipmunks around the patient's home. Control measures included active surveillance and chemoprophylaxis of 197 contacts to the victim, a community alert on methods of self- and pet-protection, and application of insecticide to reduce rodent flea populations. No secondary cases occurred. (Journal of the American Medical Association 1984;251:929–931.)     

Implementing Web-Based Learning: Evaluation Results from a Mental Health Course

SUMMARY

This paper reports on the evaluation results of a web-enhanced mental health course. The instructional design of the course was based on the principles of constructivist and collaborative learning environments. Students strongly supported the use of web-based learning in this course and found that the online environment enhanced their learning. The benefits and disadvantages of web-based learning and the implications for future course development are discussed. Issues in implementing web-based learning in social work education are also identified.     

Profiles of Risk: Maternal Health,Socioeconomic Status,and Child Health

Child health is fundamental to well‐being and achievement throughout the life course. Prior research has demonstrated strong associations between familial socioeconomic resources and children's health outcomes, with especially poor health outcomes among disadvantaged youth who experience a concentration of risks, yet little is known about the influence of maternal health as a dimension of risk for children. This research used nationally representative U.S. data from the National Health Interview Surveys in 2007 and 2008 (N = 7,361) to evaluate the joint implications of maternal health and socioeconomic disadvantage for youth. Analyses revealed that maternal health problems were present in a substantial minority of families, clustered meaningfully with other risk factors, and had serious implications for children's health. These findings support the development of health policies and interventions aimed at families.     

Utilization of Mental Health and Chemical Dependency Services:

No abstract available for this article.     

Parents' Definition of Effective Child Disability Support Services: Implications for Implementing Family-Centered Practice

The current study examined parents' perspectives of services within a community-based childhood disability program in the process of enhancing the family centeredness of its services. Qualitative interviews were conducted with 39 mothers and 22 fathers approximately 18 months after entering the service delivery system. Parents reported that effective service delivery requires service coordinators with interpersonal and practice skills working within an adequately resourced service system that has policies and procedures that are responsive to family needs. Parent feedback was congruent with the principles of family-centered practice and has important implications for the implementation of family-centered services.     

Parenting with a Disability and Child Mental Health: A Propensity Score Analysis

Little research has examined the impact of having a parent with a disability on child mental health. This study used data from 7,116 families of children who participated in the 2006 National Health Interview Survey and propensity score matching (PSM) to investigate this question. Prior to PSM, differences in Child Mental Health Brief scores were significant with a moderate effect size. After PSM, differences in Child Mental Health Brief scores were still significant, but the effect size was small. Results indicate that much of the mental health risk for children of parents with disabilities is connected to related issues.     

Family Therapy for Child and Youth Mental Health: A Scoping Literature Review

Early intervention in childhood years is an important part of successful therapies for children and adolescents living with or at risk of mental illness. Family therapy acknowledges the role of family relationships, interactions, and family systems in child and youth mental health. To explore the effectiveness and delivery of family therapy in order to inform current family therapy practice in Australian public mental health services, a scoping literature review mapped key concepts of the past 11 years of family therapy research. Current gaps were noted within the following key concepts: family therapy settings and definitions, the influence of family factors on outcomes, transparency of intervention methods, and the training of family therapists. Further research could be undertaken to address current gaps in the literature, specifically: assessment and intervention processes; typical length of time for a series of family sessions; frequency of sessions; and theoretical foundations linked with most effective outcomes, as identified by clinicians, children, and their families. This research would provide a better understanding of best practice and evidence‐based family therapy practices that work for children and their families to inform family therapy practice in Australia and beyond. This scoping literature review identified that there is a noteworthy variation in the way brief family therapy is provided, both in terms of the duration and frequency of sessions, as well as the theoretical underpinnings employed. Further research is warranted to explore different service contexts and brief versions of family therapy delivery and the outcomes for the children and their families.     

Family Therapy in Child and Adolescent Mental Health Practice: Integrating Family Therapy in Child and Adolescent Mental Health Practice: An Ethic of Hospitality

This article integrates family therapy in contemporary child and adolescent mental health services as an evidence‐based practice. An integrative practice model is proposed where contextual approaches like systemic and narrative therapy complement and enrich individual problem‐focused models such as biological psychiatry and cognitive therapy. This is based on an ethic of hospitality towards all therapy discourses and the following best practice guideline: ‘To make optimum space for a systemic and narrative understanding contributes to evidence‐based practice in a contemporary mental health service.’ After discussing some dilemmas of integrative practice, I illustrate the therapeutic process by a detailed example of integrative family therapy with a depressed suicidal adolescent.     

城乡迁移与精神健康:基于上海的实证研究

改革开放以来,中国见证了规模甚巨的城乡迁移运动,社会学界对这一现象进行了广泛的研究,但对进入城市的移民的精神健康问题则少有涉及。本研究基于对上海城乡迁移群体的多阶段抽样调查以了解这一群体的精神健康状况。问卷的分析结果显示,25%的男性和6%的女性精神健康状态不好。进一步的路径分析显示,移民压力、社会支持和迁移意义以不同的路径影响精神健康。论文建议政府和社会各界要充分回应移民群体的精神健康需求。     

Mental Health Needs and Supportive Services for Elderly and Disabled Residents

Abstract

This study longitudinally assesses the impact that the provision of supportive services has on the mental well-being of the elderly and disabled population living in independent housing developments. The results indicate that the use of supportive services by the mentally ill allowed them to overcome initial lower functional status and achieve a level of mental functioning virtually similar to that of the total resident population. Thus, it is argued that independent living facilities with supportive services can certainly be a successful and cost effective model for a number of frail elderly and mentally ill residents.     

Access Barriers to Mental Health Services for Older Adults from Diverse Populations: Perspectives of Leaders in Mental Health and Aging

This project is based on the results of telephone surveys with 52 local, state, and national informed respondents including policymakers, county leaders, planners, and advocates in mental health and aging with a particular focus on the states of California and Florida. This article addresses challenges to access to mental health services for diverse older adults including barriers related to race and ethnicity, socioeconomic status, location, age, gender, immigrant status, language, sexual orientation, and diagnosis. The article also highlights broad themes that emerged including (1) the importance of outreach and transportation tailored to diverse elders, and (2) recruitment of diverse staff and training related to diversity. The article concludes with policy and practice recommendations to reduce these disparities in access to mental health services for diverse populations of older adults.     

Introducing Evidence‐Based Family Assessment and Therapy in Child and Youth Mental Health Services: Applying Systemic Principles to Maintain,Sustain and Build Capacity

The purpose of this article is to overview the context of the mental health service in which we work, and family therapy's status prior to and after the impact of changes wrought by the introduction of the National Mental Health Policy. We then explore some key issues that we think contribute to the persistence of the occlusion of family therapy in child psychiatric services; and the strategies that we developed and are continuing to develop to support change. Finally, we describe the use of a family assessment instrument that we believe is central to our change strategy.