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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: 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.

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.