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Aimed to determine whether the diagnosis of depressive disorder in childhood has construct validity and to develop a self-rating scale for depression in childhood. (Author/DB)

• Early mobilisation is not associated with the odds of death by 30 days in this cohort of ICH patients. • Mobilisation within 24 h is independently associated with lower mean systolic BP and lower variability in diastolic BP over 24–72 h post stroke. • Our BP findings do not provide support for a policy of strict bed rest during the first 24 h after onset of ICH. Very early rehabilitation after stroke appears to worsen outcome, particularly in intracerebral haemorrhage (ICH). Plausible mechanisms include increased mean blood pressure (BP) and BP variability. To test associations between early mobilisation, subacute BP and survival, in observational data of ICH patients during routine clinical care. We collected demographic, clinical and imaging data from 1372 consecutive spontaneous ICH patients admitted between 2 June 2013 and 28 September 2018. Time to first mobilisation (defined as walking, standing, or sitting out-of-bed) was extracted from electronic records. We evaluated associations between early mobilisation (within 24 h of onset) and both subacute BP and death by 30 days using multifactorial linear and logistic regression analyses respectively. Mobilisation at 24 h was not associated with increased odds of death by 30 days when adjusting for key prognostic factors (OR 0.4, 95% CI 0.2 to 1.1, p = 0.07). Mobilisation at 24 h was independently associated with both lower mean systolic BP (−4.5 mmHg, 95% CI −7.5 to −1.5 mmHg, p = 0.003) and lower diastolic BP variability (−1.3 mmHg, 95% CI −2.4 to −0.2 mg, p = 0.02) during the first 72 h after admission. Adjusted analysis in this observational dataset did not find an association between early mobilisation and death by 30 days. We found early mobilisation at 24 h to be independently associated with lower mean systolic BP and lower diastolic BP variability over 72 h. Further work is needed to establish mechanisms for the possible detrimental effect of early mobilisation in ICH. [ABSTRACT FROM AUTHOR]

PDOT (Parkinson's Disease Occupational Therapy) was a pilot randomised controlled trial investigating occupational therapy for people with Parkinson's disease (PD) exhibiting difficulties with activities of daily living (ADL). This article describes the process undertaken to design and record the intervention. Intervention development was informed by the current evidence base and practice consensus. An expert steering group synthesised this information to develop an intervention framework. A recording tool was identified from a previous occupational therapy trial and adopted for PDOT. This was completed for all participants receiving the intervention, capturing the dose and content of therapy delivered. Nineteen participants received occupational therapy. A mean number of 5.7 visits was delivered over 60.3 days, with the initial visit lasting 60 minutes (median) and subsequent visits lasting 50 minutes (median). The intervention log demonstrated that a large proportion of therapist visits involved equipment provision/environmental adaptation, mobility/transfers/ADL training, review/discussion, and the teaching of techniques/provision of education. The intervention developed was found to be feasible and acceptable, and the findings of PDOT have been used to inform a phase III rehabilitation trial (PD REHAB). The intervention log has been revised in light of the findings and will be used within this trial. [ABSTRACT FROM AUTHOR]

There is an expectation that all occupational therapists will be evidence-based practitioners. This paper reports on an education intervention that has helped therapists working in clinical practice to respond to the challenges posed by evidence-based practice. The intervention was developed for a group of clinicians who had already undertaken an evidence-based practice course. The aim was to enable them to apply evidence-based practice skills to their practice settings. The intervention, which used the problem of evidence-tinged practice as a focus, is described and the ten commandments generated by the clinicians involved are presented for others as a potentially useful tool. [ABSTRACT FROM AUTHOR]

Occupational therapists (OTs) are often involved in the discharge of patients from hospital who have complex manual handling requirements (Shepperd et al 2013). Mobile hoists, profiling beds or commodes may be required in the patient's home which can take up a large amount of space. It must be arranged in a suitable configuration to enable safe transfers and an ergonomic working environment. Family members have reported feeling excluded from the hospital discharge process (Money et al 2011), and experience stress and conflict relating to furniture movement (Atwal et al 2008). A Project Group of OTs identified concerns relating to assessing the patient's home environment for equipment which included lack of accuracy in measurements, family members having difficulty in conceptualizing the space required, making multiple visits, additional delivery runs and increased length of stay. The Project Group identified that a portable, lightweight frame that simulates the size and space required for a single bed or profiling bed could address these issues. The frame could easily be carried by an OT to a patient's home and maneuvered around the area being assessed. The OT and the family could then cooperate in making a mutual and accurate decision regarding the placement of the equipment, and other furniture, in a single visit. This paper will present the results of the evaluation. Data was first captured on current practice (without the frame). Following training in its use, the frame was evaluated in practice by OTs across a range of clinical areas. Measures of improvement in efficiency, quality and care were gathered. A focus group was carried out to gather qualitative data on the OTs' level of satisfaction with the use of the frame, design limitations and changes to practice. Ethical approval was not required as the project does not involve patients and there are no unmanageable, foreseeable risks associated with the use of the simulator in a clinical or research setting. [ABSTRACT FROM AUTHOR]

Discusses the issues concerning the increasing presentation of aggressive children and adolescents to pediatric emergency departments in Australia. Risk factors of mental health disorders; Impetus to the limitations in the medical follow-up of the patients; Measures for promoting mental health.

A letter to the editor is presented in response to the articles by Angold in the May and October 1988 issues about childhood and adolescent depression.

Objectives: We aim to provide an overview of current issues facing child and adolescent mental health services and the provision of developmentally informed and appropriate care., Method: We review developmental models of mental disorder and the impact on service design., Results: Developmental issues can shape service design., Conclusions: Mental health services need to be informed and responsive to changing developmental needs and of the context of child development in terms of family and attachment relationships. Children and adolescents have specific needs in terms of service design.

Objective: The aim of this paper was to review the basis of the 'youth model' and new 'headspace' service delivery structures, proposed as a solution to the problem of high rates of psychiatric disorder in the youth period of life. Several issues were examined through asking key questions and answering these from the perspective of two academically oriented child and adolescent psychiatrists., Conclusions: As half of all mental disorders appear during childhood and early adolescence, more research into the origin and emergence of these problems should focus on this early period of life. Prevention research should also focus largely on children and adolescents, with interventions targeted through sequential assessment at pivotal stages. The current problem of access to mental health care for youth in the adult mental health service system could be improved with additional funding and culture change - it is not necessary to create a new service system. Indeed, there are dangers in establishing new services for 12-25-year-olds, as the 12-17-year-old population has different needs from 18-25-year-olds. In particular, the younger group are at risk of 'adultification' by being grouped together with young adults, and this risk needs to be actively managed. Health service planning must pay attention to developmental differences. Several suggestions are proposed for addressing the mental health needs of young adults.

From 1995 onwards, a child and adolescent mental health service (CAMHS) applied Senge's learning organisation model. This review compared service performance with that of peer services 5 years later and explored whether any differences were associated with the application of this model. The comparison methodology used quantitative analysis of external data from the Department of Human Services, together with qualitative analysis of material including interviews with CAMHS directors and service managers. Results showed high evaluation activity and high quality, efficiency and efficacy of care compared with other services. Several restraints to the optimal application of the model were identified, including inadequate training of new managers, service overload, major external organisational change and limited investment in information systems. Other outcomes are discussed.

Early onset dysthymic disorder (EODD) is a serious psychiatric disorder that is associated with impaired social and relationship functioning, comorbid psychiatric conditions, a chronic course and increased risk for adult affective disorders. Unlike major depressive disorder (MDD) in childhood, which has been the focus of ongoing research, EODD has been relatively neglected in clinical practice and research. This paper reviews and evaluates EODD research findings and outlines pertinent clinical and research implications.

Objective: This paper argues that adolescent psychiatry is best linked with child psychiatry and opposes separate youth mental health programmes for 12-25-year-olds. It reports on the current status of services and considers how adult mental health services (AMHS) can improve services for young adults (18-25-year-olds)., Method: Factors in development, psychopathology, prevention, training and service systems are reviewed to suggest that current child and adolescent mental health service systems (CAMHS) are appropriate for 0-17-year-olds. Improvements in CAMHS are described from a Victorian perspective, including the model of specialist clinical programmes or teams for specific patient populations. Mechanisms are outlined for AMHS to better assist young adults from 18 to 25 years of age., Results: The model of clinical projects or clinical programme teams, developed in partnership with primary health and others, is a suitable vehicle to help AMHS to improve clinical services to their young adult populations. These may be funded from a variety of sources, including re-engineering existing service resources., Conclusions: Such developments complement the work of specialist research units and build local competencies. More programme development and evaluation is needed, which will require the support of the College and State and Commonwealth Mental Health Branches.

Key Performance Indicators are used increasingly by health services, but their relevance and utility may be questionable. In this article, Program Theory is used to model the irreducible stages in the system of clinical care in Child and Adolescent Mental Health Services, define the major program operations in each of these stages, and specify the intermediate outcomes of each stage and the final outcomes sought. National and State policy standards are used, with practice experience, to identify key program operations and intermediate outcomes sought. Systematic criteria are then applied to select KPIs that are measurable, reliable, valid for our program theory, utilitarian, and relevant to clinicians, clients and managers.

Objective: The aim of this paper was to describe an organisational model that has created interest in recent business management literature as supporting learning, adaptation and continuous improvement., Method: Some key features of the literature on learning organisations are outlined, including the values and processes involved, together with a structural and cultural template that has been applied to a community child and adolescent mental health service. Some blocks to learning and the leadership skills required to develop adaptive services are described., Results: The experience of applying the model has led to a change in mental health service organisational structure and culture towards greater support for research, quality improvement, experimentation and adaptation., Conclusions: The learning organisation model offers a more comprehensive framework for designing adaptive mental health services and supporting quality management practices than any other recent organisational form.

In recent business literature, the model of the learning organisation has been proposed as a solution to the problem of continually changing environments and increasing consumer expectations of maximum quality and value for money. The model seems highly appropriate for health services, which are staffed by educated professional staff who must become more adaptive and concerned with improving consumer outcomes. This case study describes how the principles of learning organisations have been applied to the design of a new structure and the creation of a learning culture within a mental health service for children and adolescents.

Objective: This paper continues the debate, started by George Patton, that a separate adolescent psychiatry is required since many psychotic illnesses begin in late adolescence, and adolescent mental health needs have not been well met by child or adult psychiatry., Method: Epidemiological studies are used to illustrate that there are many continuities, as well as discontinuities, in the natural history of psychiatric disorders throughout the life cycle. The paper comments on rational service planning, which requires data on the outcomes of different treatment approaches. It goes on to explore the implications of a separate adolescent psychiatry for service delivery, including how current service boundaries and the training of psychiatrists might need to change., Results and Conclusions: An argument is mounted that psychiatrists should take a whole life perspective, rather than further fragment the specialty. In most Australian States, recent reviews of child and adolescent mental health services are likely to result in increased funding for services to adolescents. Adult psychiatry needs to attend more to the requirements of older adolescents, and greater collaboration is recommended between psychiatry services for children and adults. The authors argue for diversity of approaches, and consider that moves towards separate adolescent mental health services may not always be appropriate.

Objectives: The aim of the paper is to clarify the legal rights of adolescent patients, guardians and staff in Victorian Child and adolescent Mental Health Services (CAMHS). Victorian CAMHS have now been 'gazetted' and can admit patients on an involuntary basis under the amended Mental Health Act 1986 (MHA). The MHA applies equally to young people under the age of 18 years, which has raised some confusion about who has the right to consent to treatment., Method: Staff of CAMHS inpatient units have recently posed questions to the Victorian chief psychiatrist. These have included clarification of when the MHA may be appropriately used for adolescents, what is the clinician's duty of care, how to assess young people's capacity to consent to treatment, how to manage some patient groups, and what is the role of the courts in treatment decisions. The author provides a view on each of these matters, based on recent literature and confirmed by legal opinion., Results: Some matters of fact are presented and advice is provided., Conclusions: Services must seek the informed consent of guardians and adolescents and, for those young people with major psychiatric disorders who require treatment and are unable to consent, the amended MHA provides clearer direction for the use of involuntary treatment. Where units offer admission to provide assessment and stabilisation, a clear explanation about the treatment goals, and the role of restraint and medication in managing behaviour is essential at the outset of the admission process.

The many conceptual and methodological difficulties involved in evaluating depression rating scales for children are discussed. A clinical validation of the Depression Self-Rating Scale for Children (DSRSC) is described. The instrument is easy to use and has a predictive value comparable with that of a psychiatric global rating of depressed appearance and history of depression obtained at interview. There was confirmation that the DSRSC can tap an internal dimension of depression and that children are able to evaluate their feeling states. An examination of misclassified children pointed to diagnostic overlap and some unreliability of diagnosis by clinicians.