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Experimental evidence suggests that speaker and addressee quickly adapt to each other from the earliest moments of sentence processing, and that interlocutor-related information is rapidly integrated with other sources of nonpragmatic information (e.g., semantic, morphosyntactic, etc.). These findings have been taken as support for one-step models of sentence comprehension. The results from the present event-related potential study challenge this theoretical framework providing a case where discourse level information is integrated only at a late stage of processing, when morphosyntactic analysis has been already initiated. We considered the case of Basque allocutive agreement, where information about addressee gender is encoded in verbal inflection. Two different types of Basque grammatical violations were presented together with the corresponding control conditions: one could be detected based on a morphosyntactic mismatch (person agreement violation), while the other could be detected only if the addressee's gender was considered (allocutive violation). Morphosyntactic violations elicited greater N400 effects followed by P600 effects, while allocutive violations elicited only P600 effects. These results provide new constraints to one-step accounts as they represent a case where speakers do not immediately adjust to the addressee's perspective. We propose that the relevance of discourse-level information might be a crucial variable to reconcile the dichotomy between one- and two-step models., (© 2020 Society for Psychophysiological Research.)

Background: Recent policy in England has called on services for children and young people's mental health and well-being to develop and deliver local transformation plans to increase the provision of evidence-based, outcomes-informed and service user-informed treatments. The role of local leadership in service transformation is poorly understood, despite evidence suggesting it is key to enacting change., Purpose: To understand the role of local leaders and frontline practitioners in service transformation in child and adolescent mental health services., Methodology: This study was a secondary analysis of semistructured interviews with n = 20 leaders and n = 29 frontline practitioners in child and adolescent mental health services taking part in a service transformation programme., Results: Leaders' role in service transformation in child and adolescent mental health services (CAMHS) was to: (a) foster impetus for transformation by demonstrating passion and commitment for change, (b) support practitioners in developing microsystem improvements and (c) bridging the organisation's goals with available resources., Conclusions: When developing transformation plans for child and adolescent mental health services, local leaders should be transparent about reasoning and processes, enable practitioners to tailor implementation to need and provide ongoing support. Practitioner engagement needs careful planning given its crucial role in enabling collaboration that will facilitate change., (© 2018 Association for Child and Adolescent Mental Health.)

Background: Patient-reported outcome measures (PROMs) are recommended by healthcare systems internationally, but there are a number of barriers to implementation. The aim of this research was to examine the impact of training supervisors in using PROMs on clinical practice, given the importance of leadership when changing behaviour., Method: Data included pre-post questionnaires from 42 supervisors, interviews after training with six supervisees and nonparticipant observations of nine video-recorded supervision sessions., Results: After training, supervisors had more positive attitudes to administering PROMs and using feedback from PROMs and had higher levels of self-efficacy about using PROMs in supervision., Conclusions: Findings are in line with the growing body of evidence that training child mental health staff to use PROMs may be associated with changes in attitudes, self-efficacy and use of PROMs., (© 2017 Association for Child and Adolescent Mental Health.)

Jensen and Corralejo highlight that most mental health intervention research focuses on the group level rather than individual level. They looked at parent-reported outcomes for up to 24 children and found that individual-level findings appear to tell a less positive story than the more traditional group-level finding. They call for more reporting of outcomes at individual level., (© 2017 Association for Child and Adolescent Mental Health.)

Background: Policy recommends using patient reported outcome measures (PROMs), yet their use is persistently low. Our aim was to examine the association between PROM use and clinician demographic characteristics, attitudes and efficacy., Method: A sample of N = 109 clinicians completed an online survey., Results: Clinicians who reported higher levels of use of cognitive behaviour or humanistic approaches had higher levels of PROM use than clinicians who reported lower levels of use of these approaches. Clinicians who reported having received training had higher levels of self-efficacy regarding PROMs than clinicians who reported not having received training, but the effects of training on PROM attitudes and use were not significant. Still, clinicians with more positive attitudes or self-efficacy regarding PROMs had higher levels of PROM use than clinicians with less positive attitudes or self-efficacy regarding PROMs., Conclusion: Clinicians should be supported to have the knowledge, skills and confidence to effectively use PROMs in their clinical practice., (© 2016 Association for Child and Adolescent Mental Health.)

Background: With evidence of rising need around mental health in young people, cuts in specialist health provision and increasing recognition of the central role of schools in supporting young people with mental health problems, it is important to understand the provision of mental health support currently available in schools, the nature of the relationship with health and other providers of child and adolescent mental health (CAMH) services, and what are the key barriers to accessing support., Method: The study was a convenience sample survey of 577 school staff from 341 schools in England. Participants completed an online survey about the provision of specialist mental health support in their school, including what support is available, who provides it, and perceived barriers to supporting the mental health of young people. Data were linked to publicly available data on school characteristics., Results: Over two thirds of schools reported having some specialist support available, with specialist provision more common in secondary schools. Staff training and whole-school approaches were the most frequently employed specific approaches. Support was most often provided by educational psychologists, followed by counsellors. School staff particularly valued support and feedback within the schools context. The most frequently cited barrier to mental health support was the limited capacity of specialist CAMH services., Conclusions: The results suggest a need to enhance the availability of specialist support for mental health both within schools and in CAMH services., (© 2016 Association for Child and Adolescent Mental Health.)

Background: Patient-reported outcomes measures are increasingly being used in child and adolescent mental health services (CAMHS). League tables are a common way of comparing organizations across health and education but have limitations that are not well known in CAMHS., Method: Parent-rated Strengths and Difficulties Questionnaire (SDQ) outcomes data from 15,771 episodes of care across 51 UK CAMHS were analysed using funnel plots, an alternative to league tables., Results: While most services were indistinguishable from the national average there was evidence of heterogeneous outcomes and seven services had outcomes below 99.9% limits for SDQ added-value scores., Conclusions: Funnel plots are powerful tools for navigating national data and can help prompt investigations using clinical theory and local service context. Examples are provided of factors to consider in these investigations. We argue that analyses of the local context are central to the valid application of funnel plots., (© 2014 The Authors. Child and Adolescent Mental Health published by John Wiley & Sons Ltd on behalf of Association for Child and Adolescent Mental Health.)

Background: Patient Reported Outcome Measures (PROMs) are increasingly being used in Child and Adolescent Mental Health Services (CAMHS). The aim of this research was to explore change in standardized and idiographic outcome measures in CAMHS using naturalistic, routinely collected data., Method: We explored change in psychosocial difficulties and impact on daily life as evaluated by a broad standardized measure, the Strengths and Difficulties Questionnaire (SDQ) (Goodman, 1997, J. Child Psychol. Psychiatry, 38, 581) and progress toward goals as evaluated by a personalized idiographic measure, the Goal Based Outcomes tool (GBO) (Law, 2011, Goals and Goal Based Outcomes (GBOs): some useful information. London: CAMHS Press) in a sample of N = 137 CAMHS attenders., Results: Psychosocial difficulties and impact on daily life showed less change over the course of treatment than progress toward goals in this study. Change in psychosocial difficulties and impact on daily life were also less strongly associated with change in clinician-reported functioning and satisfaction with care at time two than change in progress toward goals., Conclusions: Findings of the present research may support previous studies in which service users and clinicians report that idiographic measures are more capable than standardized measures of capturing relevant change for individuals., (© 2015 Association for Child and Adolescent Mental Health.)

Background: Establishing what constitutes clinically significant change is important both for reviewing the function of services and for reflecting on individual clinical practice. A range of methods for assessing change exist, but it remains unclear which are best to use and under which circumstances., Method: This paper reviews four indices of change [difference scores (DS), crossing clinical threshold (CCT), reliable change index (RCI) and added value scores (AVS)] drawing on outcome data for 9764 young people from child and adolescent mental health services across England., Results: Looking at DS, the t-test for time one to time two scores indicated a significant difference between baseline and follow up scores, with a standardised effect size of d = 0.40. AVS analysis resulted in a smaller effect size of 0.12. Analysis of those crossing the clinical threshold showed 21.2% of cases were classified as recovered, while 5.5% were classified as deteriorated. RCI identified 16.5% of cases as showing reliable improvement and 2.3% of cases as showing reliable deterioration. Across RCI and CCT 80.5% of the pairings were exact (i.e., identified in the same category using each method)., Conclusions: Findings indicate that the level of agreement across approaches is at least moderate; however, the estimated extent of change varied to some extent based on the index used. Each index may be appropriate for different contexts: CCT and RCI may be best suited to use for individual case review; whereas DS and AVS may be more appropriate for case-mix adjusted national reporting., (© 2014 Association for Child and Adolescent Mental Health.)

Background: There is an international drive for routine use of Patient Reported Outcome Measures (PROMs) across all health services including in relation to Child and Adolescent Mental Health Services (CAMHS). A number of reviews have summarized the validity and reliability of well-being and mental health measures for children but there are fewer attempts to consider utility for routine use., Method: This review considers four child self-report measures: the Strengths and Difficulties Questionnaire (SDQ), the Revised Child Anxiety and Depression Scale (RCADS), (Child) Outcomes Rating Scale (C/ORS) and Goals Based Outcomes (GBOs). It explores the strengths and limitations of each and considers how they can be used to support both clinical practice and service evaluation., Results: There is evidence for the clinical utility of RCADS, C/ORS and GBOs, although the utility of the SDQ as a feedback measure remains unclear. For service evaluation, the SDQ has the greatest evidence for norms making it useful for comparison and there is evidence that the RCADS may be the most sensitive to change of the measures reviewed; C/ORS has issues around ceiling effect, data error and data manipulation. More research is required around GBOs before their use for service evaluation can be determined., Conclusions: In summary, these different measures may be viewed as complementary tools and determining the best way to make use of them severally and individually in clinical and community settings is a current focus for child mental health practitioners., (© 2014 The Authors. Child and Adolescent Mental Health © 2014 Association for Child and Adolescent Mental Health.)

Background: Recent policies recommend effective joint working between health and education; however, the views of service users are underrepresented, particularly opinions of young children., Method: The project was operational from 2005-2008 when interviews were conducted with parents and children. The children were attending CAMHS for mental health and educational difficulties., Results: Results indicated that they had a positive view of multiagency working. They consider that joint working is limited by a number of problems and make recommendations for improvement., Conclusions: Findings indicate that more effective communication between agencies is needed and this should be provided for parents in an accessible language. This has implications for training professionals together., (© 2012 The Authors. Child and Adolescent Mental Health. © 2012 Association for Child and Adolescent Mental Health.)

Background: Schools play an important role in promoting child mental health, but little is known about the approaches they undertake., Methods: A scoping survey in England, involving 599 primary and 137 secondary schools., Results: Although two thirds of school approaches focused on all pupils, these were predominantly reactive, rather than preventive interventions. They were also largely not evidence-based, were instead based on a plan while open to adaptation. Gaps were identified in teacher training and support., Conclusions: The findings have implications on the use of preventive versus reactive approaches, staff training and consultation, use of evidence-based practice in schools and joint care pathways., (© 2012 The Authors. Child and Adolescent Mental Health © 2012 Association for Child and Adolescent Mental Health.)

This brief commentary article considers the implications of intensive outcome monitoring which is central to children and young people's Improving Access to Psychological Therapies (CYP IAPT) in England and Wales. Services are being provided with a range of free software solutions to enable data collection, and guidance on interpretation of the measures, but there will still be some burden of data entry and collation for already overstretched services. It may be that the utility of the feedback will go some way to offset the sense of burden but this remains to be seen. Whether commissioners and others will rise to the challenge of supporting this aspect may prove crucial to the success or otherwise of such intensive ROM use. Many aspects of the CYP IAPT approach are new and whilst drawing on experience from earlier pilots of session by session monitoring in CAMHS both in the UK and abroad, and from Adult IAPT, there is likely to be much for us to learn. Time will tell whether the approach helps to improve the care children and young people receive but we are cautiously optimistic., (© 2012 The Authors. Child and Adolescent Mental Health © 2012 Association for Child and Adolescent Mental Health.)

Background:   The CAMHS Outcome Research Consortium has 44 members across Great Britain who are collaborating to introduce routine outcome monitoring into clinical practice., Methods:   Members were surveyed in 2004, in order to establish a baseline against which we could measure progress., Results:   Like Johnston and Gowers, we discovered a wide range of measures were being used, while a third of CORC members were sharing information with clinicians and commissioners, and were using it to develop clinical practice or services., Discussion:   We discuss the constraints brought up by our members and by Johnston and Gowers, as well as recent work in relation to the development of a national CAMHS dataset.

Background: Research suggests that there are differences in the problems that are referred to Child and Adolescent Mental Health Services (CAMHS) by White British and Asian families as well as differences in how these services are accessed. There is a need for more information about how different ethnic communities perceive and access CAMH services., Method: White British or Pakistani mothers of children between 0-20 years at an urban health centre were invited to complete a study-specific questionnaire written in English (with verbal translation provided when needed). Data were collected on awareness and experience of, and willingness to use CAMH services; severity of problems before referral is considered and additional factors that influence service use., Results: In comparison to White British mothers, Pakistani mothers were found to be less likely to consider a referral for problems judged as mild or moderate. There was no difference for severe problems. Qualitative factors that would enhance the use of CAMH services by Pakistani mothers include the availability of culture and gender matched therapists, and better access to translation facilities., Conclusions: The study highlights service needs and expectations of mothers of Pakistani origin, and emphasises the need for relevant, inclusive and culturally sensitive services.