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Background: Early Intervention in Psychosis (EIP) services have been implemented with the dual aims of preventing harmful outcomes associated with early‐onset psychosis and improving prognosis. However, concerns have been raised regarding the ethical implications of involving young people in EIP services. One way to ensure high ethical standards and promote good practice in EIP delivery is through governance of clinical practice. This study aimed to investigate the normative dimensions of good practice in EIP through examination of clinical guideline documents published in England over the past 15 years. Methods: A total of 14 clinical guidelines and relevant policy documents for EIP were retrieved and analysed using a mixed inductive and deductive thematic approach. Themes were derived from the data itself, whereas the development of broader categories was performed through a constant comparison with the scientific literature describing ethical issues in EIP. Results: Ethical touchpoints of good practice in EIP included both procedural and substantive factors, which were seen to be interdependent and mutually constitutive. These ethical touchpoints were largely implicit in the documents analysed. Procedural requirements of EIP service delivery consisted of norms and rules pertaining to EIP service structure, adherence to codes of ethics, inclusivity, patient and family centredness and appropriate treatment provision. Substantive factors consisted of moral attributes that should be cultivated by healthcare professionals working in EIP: competency, empathy, sensitivity and trustworthiness. Conclusions: We argue that, to ensure good practice in EIP, procedural and substantive ethical expectations embedded in EIP guideline documents should be made explicit in EIP service and care delivery. We suggest that the procedural and substantive factors highlighted in this paper contribute useful dimensions for the eventual evaluation of good practice in EIP services across England. [ABSTRACT FROM AUTHOR]

Behaviour problems make up approximately 30–50% of all referrals to child and adolescent mental health services. Behavioural parent training is one of the most effective interventions for young children. However, those families most at risk of difficulties fail to access services. This paper outlines the Children And Parents Service (CAPS), a citywide multi-agency, early intervention service to young children and their families. The intervention includes parent training groups, multi-agency training and liaison in community settings. The model of service delivery is outlined and the obstacles to service implementation and the strategies used to overcome them are discussed. The service has adopted a well validated evidence-based model of parent training, monitoring of outcomes and user involvement, and is delivered in the wider context of multi-agency systems. A thorough evaluation of service delivery models, including CAPS, would be beneficial. Whilst research trials examine the efficacy of treatments, the effective delivery of treatments within clinical services requires clarity about the place of the intervention within wider systems. The CAPS model proposes a framework for delivering interventions within these systems. [ABSTRACT FROM AUTHOR]

We are at a time of unparalleled flux in our understanding of what autism is and now to respond to it, including our understanding of the role of clinical services. For any clinician working in the context of child development and child mental health services, the majority experience is probably of overwhelming demand, and then perhaps confusion. Referrals for neurodevelopmental conditions, and particularly autism, have become an increasing proportion of UK CAMHS referrals in recent years—with the consequent lengthening of wait times extending to years, sometimes equivalent to the whole length of a child's life up until that point. Services are struggling to develop response strategies to meet user frustration, a task not helped by the fact that most interventions in current use have no good evidence of effectiveness. Consequently, a plethora of local approaches and initiatives have developed. In this article I address these clinical and related issues. I discuss current different uses of the term autism, the relation to intellectual disability, and introduce a conceptualisation of autism as emergent and transactional, which is consistent with current developmental and intervention science. This could bridge between neurodiversity and clinical perspectives and implies a framing of early intervention support that has strong clinical trials evidence and provides the basis for a rational and pre‐emptive evidenced care pathway, which I describe. [ABSTRACT FROM AUTHOR]

Background: School‐based early intervention may alleviate current emotional and behavioural problems, and, by targeting underlying vulnerability, safeguard children's future mental health. Improving on mixed outcomes to date is an international public health priority. CUES‐Ed is a classroom‐based, clinician‐led, universal cognitive behavioural programme for primary school children, designed to promote emotional literacy and regulation. Additionally, CUES‐Ed targets cognitive mechanisms implicated in the future development of mental disorder: stigmatising appraisals of emotional expression and of unusual perceptual experiences, and the tendency to jump‐to‐conclusions (JTC). We report here on fitness for purpose of our in‐service assessment of cognitive vulnerability, and change in cognitive vulnerability following CUES‐Ed and compared with a naturalistic waitlist. Methods: From 05/2017–11/2017, 960 children participated (900 CUES‐Ed; 60 naturalistic waitlist). Assessments were completed in whole classes; 732 children provided pre‐post data on all measures; 227 were missing data through absence or poor completion (n = 1 declined assessment). Results: Relationships between baseline cognitive vulnerability measures and their components were consistent with reliable and valid assessment. Cognitive vulnerability reduced from before to after CUES‐Ed and compared with the naturalistic waitlist, for JTC (large effects) and stigmatising appraisals (small–medium effects), for all children (ESs pre‐post: 0.2–1.0; between‐group: 0.1–1.0) and vulnerable subgroups (ESs pre‐post: 0.5–1.7; between‐group: 0.2–2.0). Conclusions: Targeted cognitive vulnerability mechanisms change following CUES‐Ed. As stigmatising appraisals and JTC may increase vulnerability to future mental illness, findings suggest a promise in reducing future risk. A formally controlled research study, with longer‐term follow‐up, is required to test this. Limitations and implications for future evaluation are discussed. [ABSTRACT FROM AUTHOR]

Background: Screening young people for risk of mental health difficulties in schools is an effective method to facilitate monitoring and early intervention. This study is a preliminary report on the adaptation of the Youth RADAR screening instrument for primary school children. Specifically designed to be used in schools, the Child RADAR assesses a child's balance of risk and protective factors known to be associated with the development of mental health problems. Method: Three hundred and thirty‐nine children drawn from six primary schools across NSW, Australia, completed the alpha version of the Child RADAR in addition to an assessment of depression and anxiety symptoms and subjective well‐being. Results: Confirmatory factor analysis revealed the Child RADAR to have an acceptable factor structure. Reliability for the Total Child RADAR was satisfactory based on both internal consistency (α = .86) and test–retest reliability (r = .85). Convergent validity was demonstrated through significant associations with symptoms of anxiety and depression. Conclusions: The Child RADAR shows preliminary promise as a school‐based screener of mental health risk. Further evaluation is required to demonstrate the generalizability of the instrument across different populations. [ABSTRACT FROM AUTHOR]

Background: Many CAMH Services have Tier 2 provision in primary care, but there has been little published evaluation. In a service aimed at general practice, this study examined: 1) the clinical activities of the primary mental health workers; 2) the effect of the service on referrals to specialist CAMHS; and 3) the utilisation and perceived usefulness of the service. Method: clinical activity data collection, evaluation of referral patterns, and a postal questionnaire. Results: Informal (unstructured) consultation-liaison was used more than formal consultation. Referrals to specialist CAMHS increased from practices using the service. The service was perceived as helpful and accessible. Conclusions: The service supported primary care staff in their work with child and adolescent mental health issues. Referrals to Tier 3 may increase as a result of the service. [ABSTRACT FROM AUTHOR]

In the last 10 years the problem of exclusion has reached a crisis point. Research suggests that exclusion is a complex phenomenon that needs involvement from all the involved services such as Health, Education and Social Services. One hundred and twenty-four pupils, aged 4–12 years who, through school and social exclusion, were at risk of developing more serious mental health difficulties, were randomly allocated to standard care ( n = 62) or standard care plus the new intervention ( n = 62). There were no significant differences in the primary outcomes between the two groups at either of the outcome assessments. However, the intervention group with non-compliance cases removed from the analysis did significantly better ( p < . 014, 95%CI −12.8 to −1.4). The Home and School Support project managed to reduce the number of excluded days and the appearance of mental health symptoms for pupils who engaged fully with the intervention. The project also highlights the importance of multi-agency involvement at a very early stage. [ABSTRACT FROM AUTHOR]

A community-based early intervention psychology service for pre-school children with emotional and behavioural problems is described. The intervention included parent training groups, a weekly open clinic, and multi-agency training, liaison and consultancy. The aims were to provide successful intervention to families, to maximise liaison with community staff and to provide a seamless service to and from the main hospital department. Evidence indicated improvements in parental coping and children's behavioural difficulties using standardised measures and gains were maintained at 6- and 12-month follow-up. This article outlines a framework for service delivery in a small community with high socio-economic deprivation. [ABSTRACT FROM AUTHOR]